MEDICO-LEGAL STUDIES, 
VOLUME III. 
BY 
CLARK BELL, ESQ,, 
Of the New York Bar. 
Editor Medico-Legal Journal. 
Published, by the Medico-Legal Journal, 
57 Broadway, 
New York. 
1893- This volume is one of an edition of five hundred, of which this is No. 
Entered according to act of Congress in the year 1893 by Clark Bell, Esq., 
in the office of the Librarian of Congress at Washington, D. C., U. S. A. 
Copyrighted—All rights reserved. DEDICATION. 
To the memory of— 
Hon. E. E. BERMUDEZ, 
Chief Justice Supreme Court of Louisiana, 
An upright, just judge, an honorable gentleman, a wise 
and discreet counsellor, a warm, true, and faithful friend, an 
affectionate husband and devoted father, I make this trib- 
ute to one whom I was proud and glad to call my friend. 
New York, January, 1893. 
CLARK BELL. Eminent Medico-Legal Jurists and Medicae Men of the Medico-Legal 
Society, and of the International Medico-Legal 
Congress of 1893. 
PROF. DR. JEAN MIERZEJEWSKI, PROF. DR. FRANZ VAN HOLTZENDORFF, 
of St. Petersburgh. of Munich. 
EX-JUDGE ABRAM H. DAILY, 
DR. F. E. DANIEL, President-Elect Medico-Legal Society. A. F. EGGLESTON, ESQ., 
Austin Texas. (State Attorney,) Hartford, Conr.. 
EX-JUDGE A. J. DITTENHOEFER, JUDGE DAVID H. BREWER, 
of New York City. Supreme Court of the United States. 
CHANCELLER JOHN A. FOSTER, CHANCELLER COBB, 
of Alabama. JUDGE MATTHEW P. DEADY, of Alabama. 
of Oregon. 
DR. ROBERT J. NUNN, DR. J. T. SEARCEY, 
of Savannah, Ga. of Alabama. PREFACE. 
I have found time in an active professional life to write 
occasional sketches upon medico-legal topics, some of which 
were read before the Medico-Legal Society of New York, 
and others were written for the editorial columns of the 
Medico-Legal Journal. 
Those contained in the present volume are such as have 
been thus prepared since January, 1891, which I have col- 
lected in this form to preserve them for reference and for 
the benefit of students of forensic medicine. 
The first two series of the forthcoming volume of the His- 
tory of the Supreme Court of the States and Provinces of 
North America, edited by myself, have appeared just before 
the publication of this work, and I take pleasure in present- 
ing in the illustrations of the present volume portraits of 
members of the Bench of the Supreme Court selected from 
those series from the States of Texas, Kansas, New Jersey, 
and Oregon, as well as of others identified with the Medicor 
Legal Society and its labors, and the American International 
Medico-Legal Congress of 1893. 
Dated, New York, January, 1893. TABLE OF CONTENTS. 
Hypnotism and the Law 1 
Views of— 
Prof. George Trumbull Ladd 3 
Prof. Paul Cams 5 
Prof. William James 6 
Prof. Joseph Jastrow 6 
Prof. C. H. Hughes 7 
Prof. Archibald Church 9 
Hon. G. A. Endlich 10 
Judge John F. Dillon 10 
Chancellor Gibson 10 
Judge T. J. Barnett 11 
Morris Ellinger, Esq 13 
Dr. William H. Palmer 15 
Mr. Wilson McDonald *'19 
Dr. Henry S. Drayton 20 
Mr. Julian Hawthorne 21 
Dr. Paul Gibier 24 
Dr. E. P. Thwing 25 
National and State Chemists in Courts of 
Law . 29 
Mechanical Restraint in the Care and 
Treatment of the Insane. . ..: 35 
Views of— 
Dr. Theodore Diller 40, 118 
Dr. Peter Bry 43 
Dr. P.M. Wise ... 43 
Dr. William B. Fletcher 47, 50, 137 
Dr. Charles W. Pilgrim 51 
Dr. G. Alder Blumer 53 
Dr. John B. Chapin 53 
Dr. D. Hack Tuke 54 
Dr. Henry Mandsley 55 
Dr. L. A. Tourtellot 56 
Dr. James Olmstead 58 
Dr. Carlos F. MacDonald 59 
Dr. Gershom H. Hill 60 
Dr. Selden H. Talcott 61 
Dr. William W. Godding 62 
Dr. John Curwen 62 
Dr. H. P. Stearns 63 
Dr. Richard Dewey 63 
Dr. C. H. Hughes 66 
Dr. Samuel H. Lyon 66 
Dr. J. T. Stearns 67 
Dr. L. H. Prince 68, 71 
Dr. G. R. Trowbridge 73 
Hon. W. P. Letchworth 75 
Dr. Daniel Nicholson 76 
Dr. W. Thornton Parker 77 
Dr. Henry M. Hurd 78 
Dr. James Moncure 78 
Dr. W. Orange 79, 81 
Dr. Ralph L. Parsons 83 
Dr. James H. McBride 84 
Dr. Richard Greene 85 
Dr. C. B. Burr 86 
Dr. Needham 89 
Dr. Powell 89 
Dr. Tate 90 
Dr. G. A. Tucker 90 
Dr. D. Yellowlees 91 
Dr. W. W. Ireland 93 
Dr. Alex Robertson 95, 113, 122 
Dr. Campbell 116 
Dr. Howden 116 
Dr. Alice Bennett 125 
Dr. Walter S. Fleming 130 
Dr. Ira O. Tracy 131 
Dr. Stephen Smith 131 
Dr. C. K. Bartlett 133 
Dr. H. A. Buttolph 134, 135 
•Dr. Dwight Shumway Moore 136 
Dr. Daniel Clark 138 
Retiring address as President Medico- 
Legal Society 97 
Medical Jurisprudence, the Bar, and the 
Judiciary 101 
The Presidency of the Medico-Legal So- 
ciety 112 
Blood and Blood Stains in Medical Juris- 
prudence 145 
Tables of Prof. Wormley 163, 173, 175 
Dr. Formad’s Comparative Tables 166 
Gullivers’s Tables 168, 169, 170, 171 
Welcker’s Tables 171 
Views of— 
Dr. William J. Lewis 157 
Prof. John J Reese 159 
Prof. M. D. Ewell 180, 188 
Dr. Robert Reybum 181 
Prof. Formad 152, 183, 186 
Dr. R. J. Nunn 184 
Dr. Ira VanGiesen 184 
Dr. F W. Draper 185 
Prof. Wormley 185 
Dr. Charles fletizman 185 
Medico-Legal Society 190 
Micrometry 185 
Legitimacy 191 
Criminal Responsibility of the Insane 
Homicide 193 
Non Compos Mentis 197 
Moral Insanity in the Courts I98 
Insane Delusions 199 
Monomania 200 
Drunkenness as a Defense 202 
Delirium Tremens 205 
Memorandum 206 
Tenancy by the Curtesy 207 ILLUSTRATIONS. 
Gen. Thomas Ewing, ist Chief Justice of Kansas facing title page 
Group of Eminent Legal and Medical Men facing preface 
Group of Texas Judges and ex-Judges Supreme Court i 
Chief Justice John W. Stayton, of Texas 8 
Judge John L. Henry, Supreme Court of Texas 16 
Judge R. R. Gaines, Supreme Court of Texas 23 
Group of Judges, Texas Court of Appeals 32 
Group of ex-Judges, Texas Court of Appeals 35 
Group of Eminent Alienists and Medical Men 43 
Judge Daniel M. Valentine, Supreme Court of Kansas 56 
Judge William A. Johnston, Supreme Court of Kansas 60 
Chief Justice Mercer Beasley, of New Jersey 64 
Judge Daniel A. Depue, Supreme Court of New Jersey 72 
Judge Edward W. Scudder, Supreme Court of New Jersey 80 
Judge Bennet Van Syckel, Supreme Court of New Jersey 80 
judge Alfred Reed, Supreme Court of New Jersey 88 
udge William J. Magie, Supreme Court of New Jersey 88 
Judge Charles G. Garrison, Supreme Court of New Jersey 100 
Judge George T. Werts (Governor), Supreme Court of New Jersey 100 
Chancellor Alex T. McGill, and Presiding Judge New Jersey Court of Errors and Appeals.. 104 
Vice-Chancellor Henry C. Pitney, of New Jersey 112 
Vice-Chancellor Robert S. Green, of New Jersey 122 
Judge Abram C. Smith, Lay Judge Court of Errors and Appeals New Jersey 144 
Red Blood Corpuscles 146. 153, 156, 157 
Red Blood Corpuscles, side view 147 
Haematin Crystals 151 
Sorby’s Spectroscope Eye-piece 153 
Blood Spectra, facing 154 
Fresh Human Blood 160 
Blood of Sheep 160 
Blood of Goat and Man 161 
Blood of Ox and Dog 162 
Prof. Wormley’s Tables 163, 173 
Formad’s Comparative Tables 166 
Gulliver’s Tables 168, 169, 170 
Welcker’s Tables 171 
Prof. Ewell’s Diagrams 177, 178, 179 
Prof. Ewell’s Micrometric Measurements 188, 189 
Chief Justice William P. Lord, of Oregon 193 
Ex-Chjef Justice R. S. Strahan, of Oregon 193 
Judge Robert S. Bean, Supreme Court of Oregon. 193 
Group of ex-Judges Supreme Court of Oregon 202 HYPNOTISM AND THE LAW. 
CLARK BELL, ESQ. 
A large part of the session of the Medico-Legal Society 
of February, 1891, was given to the discussion of the legal 
questions which had been formulated by the Standing Com- 
mittee on Hypnotism, and made the standing order for dis- 
cussion, viz.: 
1. Has the sensitive sought the operator, or has the operator used undue 
influence to gain control of him ? 2. Are proper witnesses present ? 3. 
Are possible elements of error eliminated, such as self-deception, simula- 
tion and malingering ? 4. Is hypnosis a justifiable inquisitorial agent ? 5. 
Do w'e need a reconstruction of the laws of evidence in view of the perver- 
sion—visual and otherwise—created by the trance ? 6. Is any revision of 
the Penal Code desirable in view of these facts ? Finally, should there be 
legal surveillance over private experiments or public exhibitions ? 
The Eyraud Bompard case, tried at the Paris Cour d’As- 
sizes de la Seine, had attracted the attention of the world, 
and the sharply-defined lines that marked the divergent 
schools of Nancy and La Saltpetriere was arousing deep 
interest in scientific circles, both sides of the Atlantic, which 
was not greater than the general public interest everywhere 
manifested by laymen. 
Brouardel and the disciples of the schools of La Saltpe- 
triere show by their testimony that they regard hypnotism 
as a pathological condition peculiar to hysterical or other 
nervously indisposed but peculiarly susceptible persons, 
characterized by the three periods of cataleptic-lethargic 
sleep and somnambulism, into which the subject could be 2 
HYPNOTISM AND THE LAW. 
successively thrown by manipulations or manoeuvres of 
various kinds. That it was, so to say, a diseased state of 
the subject susceptible to these influences and conditions 
which occasionally occurs, but rarely, in persons of normal 
and healthy condition. 
The report of the experts, Dr. Brouardel, Motet, and Gil- 
bert Ballet, in the Bompard case, show this was their view. 
The school of Nancy, on the contrary, affirms that nearly 
every one is subject to hypnotic influences, naming 90 per 
cent, of the human race, and that at least 50 per cent, can be 
placed in the somnambulistic state. They discard the theory 
that it is a diseased condition, or only felt by the hysterical 
or weak mentally, but aver that hypnotism is only a mani- 
festation of a natural phenomena. 
Prof. Liegeios and his confreres regard hypnotism as a 
psychological condition. Prof. Brouardel and his associates 
as a pathological state. 
This trial does not, therefore, clear the air of the difficul- 
ties of the Medico-Legal inquiry, whether crime can be 
committed by the suggestion of the hypnotizer, of which 
the subject is the innocent, and also unconscious, actor. 
Brouardel believed Bompard responsible. What most 
interests us now is the inquiry, can crime be thus committed 
by suggestion ? 
The exponents of the Nancy School show very clearly 
that it can. Would Professor Charcot or his disciples say 
that in case of a veritable subject it could not? 
In view of the situation, I sent a copy of the report of 
the committee to a few eminent men in this country, and 
have and shall do so to others abroad, to obtain clear and 
concise responses to such of the legal questions as are asked 
in the report, and I give herewith some of the responses, of 
which not a few were read at the February meeting, as well 
as the discussion at that session. HYPNOTISM AND THE LAW. 
3 
Prof. George Trumbull Ladd, one of our most eminent 
members, says: 
Yale University, New Haven, February, ’91. 
Mr. Clark Bell. 
Dear Sir I regret that I cannot be present at the approaching discus- 
sion of the “ Medico-Legal Aspects of Hypnotism.” But I will endeavor 
to compress into a brief statement some of the opinions which, if present, 
I should wish to maintain. 
In the first place, it seems evident to me that the subject of Hypnotism 
has not yet reached the stage of evidence and knowledge which warrants 
any considerable changes in the civil or criminal laws. 1 he laws are gen- 
erally about the last parts of the social structure which can safely feel the 
effects of special scientific researches and discoveries. Science must take 
full possession of hypnotism, as the essential pre-requisite of any consid- 
erable changes in the laws. And in advancing the cause of science over the 
domain of these phenomena, nerve-physiology and psychology should go 
hand in hand. I believe that professional psychologists generally are very 
eager to learn all they can from physiology on this subject. I wish I could 
he equally sure that physiologists and physicians were as eager and willing 
and docile in their attitude toward the science of psychology. 
The law may well—and perhaps at ©nee—take cognizance of the truth 
that science, and science alone, is the only rightful and judicious con- 
troller of this domain. It should, it seems to me, suppress all public exhi- 
bition of hypnotic subjects, or general practice of hypnotism by incom- 
petent persons; it should be ready to interfere on evidence that any citizen 
is being subjugated by any experimenter for purposes merely of gain or 
other private ends. The protection of the inmates of public institutions 
from injury to health, and other ill consequences, must necessarily he a 
more difficult matter for the law to take in hand. 
Certain crimes committed on hypnotic subjects are, of course, already 
pretty carefully guarded by legal enactments or by principles of common 
law. Deeds, notes, gifts, promises and wills made under hypnotic control, 
whether in hypnotic or post-liypnotic states, should in general be considered 
void; this, I think, should be the principle, whether such instruments are 
of a kind likely to be made by the same person uninfluenced by hypnosis, 
or not. Of course, to determine whether there has been hypnotic control 
must be a matter of evidence in each case. I do not see, then, why we 
should not have the same necessity for recognizing the value of expert 
testimony, which arises constantly now in cases of alleged insanity, or 
“ undue influence” of other than hypnotic sort. 
I see no objection to the careful guarded examination of witnesses, or of 
accused persons, by expert and trustworthy hypnotizers—when sanctioned 
by the Court. If my present view of the phenomena is correct, such an 
examination could rarely or never be very productive of information 
unless the person under examination consented to be hypnotized. Evi- 
dence thus obtained, however, should be used, it seems to me, only as 
indicating where legally usable and valid evidence might be obtained and 4 
HYPNOTISM AND THE LAW. 
not as itself, legally usable and valid. In case of a jury trial, such exam- 
ination should perhaps be before the judges, but not before the jury. 
The determination and punishment, where crime is proved to have been 
committed under hypnotic influence, is necessarily a very difficult and com- 
plicated problem. But when science has done her more perfect work—and 
that in no very distant future—I cannot see why these should be any more 
difficult than cases where crime is committed by one alleged to be insane. 
In botli classes of cases we simplify our problem very much, however, if 
we take what is now known as the “Anthropological ” view. As to the 
responsibility of the individual to the moral law I take what is called the 
“classical ” view. I believe, as most of those holding the anthropological 
view do not, in the freedom of the will, and in the reality of guilt, as dis- 
tinguished from the fact of crime. But I am inclined to think, more and 
more, that society should deal with crime solely in a way—on the average 
and in the long run—best to protect itself and promote its own social 
welfare. 
Suppose, then, that a crime has been committed under hypnotic influence. 
The law should treat both the criminal who suggests, and the hypnotic 
subject, the criminal (I do not say the guilty person) who receives the sug- 
gestion, according to the broadest and most humane sociological principles. 
Both persons might be—very properly, as it seems to me—deprived of lib- 
erty, in such manner as the interests of society dictate. Perhaps the prison 
for one, and the insane asylum for the other, would not be inappropriate. 
Under present conditions, the “ punishment ” of both might not go far- 
ther astray from their respective deserts than is customary with our clumsy 
human justice so-called. 
I am well aware that the extreme case of murder would prove a very 
perplexing one. I am not as yet satisfied that such a case is at all likely to 
occur. But should it occur, it would probably be well nigh impossible to 
secure the death penalty for either party. 
I am well aware, my dear sir, how foolish and premature much of the 
little I have written will seem to your committee. I shall be much pleased 
to learn wisdom on this subject from those wiser than myself. 
The one thing on which I most wish to insist is this, that, for the 
present, science alone should possess this field. The first business of the 
law is to keep out those whose researches are not solely in. the interests of 
science, and so, ultimately, of humanity; its next business is to learn 
from science whenever the scientific investigators can agree upon their 
report. 
I am yours respectfully, 
GEORGE TRUMBULL LADD. 
Prof. Paul Carus, tlie gifted editor of the Monist, says : 
Chicago, III., Jan. 30. 1891. 
Clark Bell, Esq., President Medico-Legal Society. 
Dear Sir.—Although hypnotism is not a disease in itself, the neurotic 
conditions that predispose a subject for liypnotization are of an ominous 
nature, in so far as they can at any time become the means of depriving 
that person of his or her self-control, and make him or her an easy tool HYPNOTISM AND THE LAW. 
5 
for crime under the intluence of unscrupulous men. For this reason it 
should not be allowed that any person should hypnotize except with the 
subject’s consent and also for weighty medical reasons. Nor should un- 
skilled persons be suffered to practice hypnotism. Laymen should as little 
tamper with psychical experiments as non-physicians should be suffered to 
practice medicine. 
Hypnosis, viz., sleep artificially induced by psychic means, can be used 
as a valuable therapeutic agent, especially when insomnia is the cause of 
the disease. As an anajsthetic, however, it is not to be commended. Nar- 
cotics are still more efficient and more reliable. Hypnotism should never 
be employed for cases of confinement (as is done in Parisian clinics'), be- 
cause it stands to reason that it produces a predisposition for hypnosis in 
the child. The physician has no right to inflict such a blight upon the 
budding life of a man—nor has the mother either—only to free her from 
an hour of pain. In saying this I do not deny that the experiments of Ur. 
Luys, who employs hypnotism in case of childbirth, will most likely prove 
to he of great scientific value. 
Concerning the legal aspects which you present, I should say that, ac- 
cording to a rational interpretation of our laws, it would be punishable 
for the operator to seek control of the sensitive subject unless demanded. 
[In answer to point 1.] 
Proper witnesses should be present whenever the slightest doubt in the 
honesty of the operator can arise. [In answer to point 2.] 
Hypnosis is a justifiable inquisitorial agent for finding clues, but it has 
not the slightest value if considered as evidence [in answer to point 4]; 
because it is extremely difficult to remove the many sources of error, 
simulation and also, perhaps most so, of self-deception [In answer to 
point 3.] 
We need no reconstruction of the laws of evidence. A wise and suffi- 
ciently broad application of the present laws will be found to be sufficient. 
Nor do I mean to have laws passed to enforce protection against malprac- 
tice. I trust that our present laws suffice to protect the ignorant against 
psychical quackery as far as protection is advisable. No new laws are needed 
—supposing that the judges are competent men who understand how to 
make the proper application of those laws that prohibit nuisances of a 
similar kind. [In answer to point 5.] 
Concerning the Penal Code, however, I should say [in answer to point 6] 
that it is highly desirable to revise it according to the scientific maxims 
which can be derived from the data brought to light by modern psychology, 
in the sense proposed by modern criminologists. I would not advise treat- 
ing the criminal with sentimental humanitarianism, but treating crime as a 
moral disease, to cure it effectually without letting the criminal suffer more 
than exactly necessary. At present the criminal is sometimes punished 
more severely than he deserves, and crime is preserved. Our penal insti- 
tutions should become asylums, not for penal purposes, but for moral cures, 
and also for separating injurious elements from society. 
Respectfully yours, 
P. CARUS. 
Prof. William James, of Cambridge, says : 6 
HYPNOTISM AND THE LAW. 
Cambridge, Mass, January 23, 1891. 
Clark Bell, Esq. 
Dear Sir I appreciate the compliment which you pay me in asking 
for a letter to be read at the discussion of hypnotism before the Medico- 
Legal Society. 
My experience has been too small to justify me in having any personal 
opinion about criminal suggestion, etc. I entirely reject the notion of 
using hypnotism inquisitorially, and in my eyes the less legal surveillance 
there is over private experiments or public exhibitions, the better it will be. 
Very truly yours, 
WILLIAM JAMES. 
Prof. Joseph Jastrow, of the University of Wisconsin, 
says : 
Madison, Wis., February 1, 1891. 
Clark Bell, Esq., New York : 
I)eak Sir I take pleasure in saying a few words in answer to your 
kind invitation. I am glad to see that the subject of Hypnotism is being 
seriously taken up amongst us. In so doing we should profit by the ex- 
perience of our foreign brethren and avoid the dangers into which they 
have in some part fallen. Should the result of your deliberations be the 
suggestion of some legislation restricting the practice of hypnotism I 
trust it will be framed broadly enough to include its use by professional 
psychologists and others of scientific standing. To limit it to physicians 
solely, seems to me to be going too far ; there is nothing in the M. D. de- 
gree that will prevent its abuse, nor does such abuse follow from the 
absence of such a degree. The prime object is to prevent public exhibi- 
tions that count only upon idle curiosity for their support, and dilletante 
meddling with dangerous practices, and to restrict the practice of Hypno- 
tism to scientific purposes ; amongst these I count as highly important 
the deductions which the modern students of Experimental Psychologists 
have drawn from hypnotic experiments with reference to normal mental 
processes. 
Of the points stated in your report, I would take exception only to the 
third, in which you state the position of the Paris school. It seems to me 
from my reading, from my personal experience with subjects and from 
what I saw at Paris and at Nancy, that the Nancy view, which regards these 
three stages as accidental and insignificant variations of what is really a 
very variable condition, (the exact nature of which we do not clearly under- 
stand), is the true one. Lethargy, somnambulism and catalepsy appear as 
the results of suggestion (conscious or unconscious) and the precise distinc- 
tions between them are rarely obtainable. 
The legal aspects of the subjects are certainly serious, and the experi- 
ments of Liegeios open out alarming possibilities. How far these facts 
should influence legislation is, of course, a most delicate inquiry, upon 
which I can have no professional opinion. When we consider the variance 
between medical science and legal practice upon the question of insanity 
and responsibility, we cannot be very sanguine of the acceptance by the Law 
of the fruits of scientific investigation. 7 
HYPNOTISM AND THE LAW. 
I shall follow with interest the progress of your deliberations, and trust 
you will find it possible to keep me informed of your doings. 
Very truly yours, 
JOSEPH JASTROW. 
Dr. Charles H. Hughes, Professor of Nervous Diseases 
and Psychiatry, Marion-Sims College of Medicine, and 
editor of the Alienist and Neurologist, St. Louis, says: 
St. Louis, Mo., January 20, 1891. 
Clark Bell. Esq. 
I am, in the main, in accord with the report of the Committee. My views 
upon one aspect of this interesting subject have been already expressed in 
a recent editorial in the Alienist and Neurologist, referring to the Eyraud 
Bompard case, which permit me to here quote. 
“ This trial, in its psychological aspect, is the most remarkable of modern 
times. No plea since the days of Cotton Mather, when witchcraft occu- 
pied the public mind and theories of obsession were offered in extenuation 
of reputed crimes, has possessed so much interest to students of psychol- 
ogy and psychiatry. The names of the medical experts appearing as wit- 
nesses on both sides of the case are those of men distinguished for their 
contributions to science and their studious research. Both Professor Lie- 
geios and Professor Brouardel, the first testifying in favor of hypnotic in- 
fluence, and the second controverting it, are eminent in the medical profes- 
sion of France. The hypnotic school of Nancy is justly renowned, and the 
conclusion of Professor Liegeios, a pupil of Bernheim, that Gabrielle 
Bompard was a hypnotic subject, carries with it the weight of an authority 
respected wherever hypnotism is studied and understood. But Charcot and 
Brouardel are likewise at least fully as eminent. 
There seems no reason to doubt that the girl was susceptible to mesmeric 
influence, and more or less under the dominion of Eyraud, who was, at 
least, the leading agent in the murder. Whether Bompard was a willing or 
unwilling subject does not appear from the testimony as transmitted over 
the cable. The girl’s previous life, however, her early history of evil habits 
and neglected education, requiring unusual restraints and coercions, as set 
forth in the address of the Procurator-General, would indicate that she was 
an apt and consenting accessory to the crime. 
The condition of hypnotic criminal suggestion is a subject yet to be 
elucidated by science and before the courts. Notwithstanding the uncer- 
tainty which invests this case, great crimes may be committed under hyp- 
notic suggestion. This possibility has been demonstrated by Mesmer and 
his pupils, by Charcot and Bernheim, but before any of these, with the ex- 
ception of Mesmer, the previous experiments of Braid, the Manchester 
surgeon, also show its possibility. There is no reason to doubt, from what 
we know of the possibilities of Braidism, or hypnotic suggestion, that 
crimes as well as the cure of diseases may be accomplished through its 
influence. 
But crime under the influence of hypnotic suggestion would be what is 
implied in the expression—an act, every step of which would be suggested 8 
HYPNOTISM AND THE LAW. 
by the liypnotizer to the hypnotized. If all the steps necessary to the ac- 
complishment of a crime are anticipated by the hypnotizing agent having a 
criminal intent, the subject would doubtless carry out minutely all the sug- 
gested details ; but the intervention of any circumstance or eventuality not 
reckoned upon by tbe liypnotizer in planning the execution would undoubt- 
edly upset entirely its voluntary execution. 
The difficulty in the way of accomplishing crime under hypnotic influ- 
ence would be in the operator’s failing to anticipate every possible resist- 
ance, and providing for it by suggestion. It is owing to this fact—and it is 
fortunate it exists—that crimes under hypnotic influence can very seldom 
occur. To illustrate : A villainous liypnotizer, with murderous intent, sug- 
gests to the subject of his influence that at a certain time he shall proceed 
to a certain house where he will find his proposed victim lying in a certain 
room, in a certain bed and in a certain position. The successive steps of 
this crime are all carried out by the subject, but tbe victim does not happen 
to be at the place suggested. The individual acting under suggestive con- 
trol can do no more in the accomplishment of this intended crime except 
he awakens from his hypnotic trance and completes the act under the im- 
pulse of his own normal volition. This fact, then, would render the per- 
petration of crime under hypnotic suggestion ordinarily impossible. Tbe 
subject, acting hypnotically, is liable to encounter in almost every instance 
unsuggested and unprovided for contingencies. 
When the plea of hypnotic influence is advanced in extenuation of crime 
the presumption from what we know of this phenomenon would be against 
its entertainment. The scientific and the legal presumption would, in such 
a case, I think, be identical—that is, against the theory of hypnotic irre- 
sponsibility. For the reasons here made apparent I think that the start- 
ling fears expressed in many quarters as to hypnotic power being generally 
abused, are groundless, and that, while crime may be perpetrated under its 
influence, the difficulties in the way of its operation are sufficient to hold 
its abuse in check. Nevertheless, in criminal procedures, as well as in civil 
ones, courts ought not to lose sight of this possible ‘ undue mental influ- 
ence. ’ Its tendency is to develop a morbid condition of the mind and an 
unstable state of the psychical centers. This is a substitution of one dis- 
ease for another, and is profitless in a medical sense. The practice of 
mesmerism destroys the subjects mental equipoise, renders him more or less 
abeyant to that of the operator, and obliterates his normal individuality. 
For this reason, to practice it indiscriminately is criminal, and should be 
made so by the law, as it is in many countries.” 
There are degrees of responsibility in hypnosis dependent upon the cir- 
cumstances under which the condition is induced or permitted to be in- 
duced by the subject, just as there are degrees of criminal responsibility 
where crime is perpetrated under the dominant impulsion of alcoholic 
inebriety. 
The subject who, knowing his failing and his madness, meditates in 
calmer and uninfluenced moments a crime and then puts himself in the way 
of being helpless to resist the impulsion of alcoholic toxhaemia or resistless 
hypnotic suggestion, takes a voluntary initial step in the direction of crime 
which, in my judgment, should be punishable by law. HON. JOHN W. STAYTON, 
Chief Justice Supreme Court of Texas. HYPNOTISM AND THE LAW. 
9 
In criminal procedure it would seem proper that the law should take cog- 
nizance not only of the involuntary condition but of the voluntary steps 
preceding it and hold the operator and willing subject alike as criminal, 
though perhaps in varying degree, as principal and accessory before the 
fact. The first question of the Committee is, therefore, a significant and 
eminently proper one, and all the others arc likewise important. 
The subject is many sided. Hypnosis, to detect crime, should be undoubt- 
edly a justifiable procedure in so far as involuntary self-crimination would 
be justifiable by law, no further. The facts of visual, auditory and tactile 
perversion demand, under certain evident conditions, such as we now have 
under consideration, a partial revision and reconstruction of Criminal Law, 
and public exhibitions of hypnotism should be prohibited by law, as injur- 
ious to the subject and subversive of public health and morals. 
I regard hypnosis, or somnavolism, as I have preferred to call it, as an in- 
duced morbid impressibility of the psychical and psychomotor centers of 
the cerebrum, and as such I consider it a condition of functional cerebral 
disease, which we are not morally justifiable in inducing or provoking in 
susceptible persons without good reason. 
It is an unnatural functional impressibility of the brain, which should 
neither be encouraged by science or permitted to be promiscuously or pub- 
licly practiced by law. 
C. II. HUGHES. 
Prof. Archibald Church, of Chicago, responds, in behalf 
of the Medico-Legal Society of Chicago, as follows : 
1G7 Dearborn St., Chicago, February 9th, 1891. 
Clark Bell, Esq.; 57 Broadway, New York. 
I)kar Sir:—Your note of the 31st ult., and the report of your standing 
committee on Hypnotism, have been referred to me by Dr. Doering, as the 
chairman of a committee of the Chicago Medico-Legal Society, appointed 
under a resolution adopted at the December meeting, to secure legislation 
controlling the public and indiscriminate employment of the hypnotic 
state. The resolution mentioned pointed out the moral dangers of hypno- 
tism and its medico-legal bearings, with the recommendation that its use be 
limited, under penalty, to properly qualified medical men, and that even 
then it be never employed except in the presence of other medical men or 
elose friends of the subject. It was specifically directed against public 
seances of hypnotism, magnetism, etc. Herewith I hand you a clipping 
showing what has been done in Cincinnati. 
We are having a bill prepared to go before the present session of the 
State Legislature in furtherance of these ideas. 
Very truly yours, 
ARCHIBALD CHURCH. 
Hypnotism in Cincinnati. 
The Common Council of Cincinnati has just passed an ordinance making 
it a misdemeanor to give hypnotic exhibitions. Dr. J. W. Pendergast, 
Health Officer of that city, is of the opinion that hypnotism, when applied 10 
HYPNOTISM AND THE LAW. 
indiscriminately, is injurious, as it affects the mental health of the subject, 
and recommended the enactment of the ordinance. A lecturer on hypnotism 
was refused a license and obliged to leave the city.—Journal of American 
Medical Association, February 7th, ’91. 
Hon. G. A. Endlich, Editor of the Criminal Law Maga- 
zine, responds as follows : 
Reading, Pa., February 7tli, 1891. 
Clark Bell, Esq., 
Dear Sir :—It will not be possible for me to attend the meeting on Feb- 
ruary 11, as you kindly suggest. Nor do I feel myself sufficiently clear 
upon the subject of hypnotism to make what I could say of any value. It 
is one upon which rasli talking is out of place. But I am strongly of the 
opinion that, in the present state of our knowledge of it, there ought to be 
some legal control exercised over experiments and exhibitions in this field. 
Thanking you for your article, and hoping to hear from you again, 1 
remain, my dear sir, 
Very truly yours, 
G. A. ENDLICH. 
Chancellor Henry R. Gibson, of Tenn., writes : 
Knoxville, Tenn., February 2d, 1891. 
Clark Bell, Esq., New York, 
Dear Sir In my investigation of Hypnotism, I have not reached a 
point of observation from which I have any views. 
I would be glad to have all the literature on the subject the Society may 
be circulating. 
Very respectfully, 
HENRY II. GIBSON. 
Ex-Judge John F. Dillon, says : 
Clark BELL, Esq., 57 Broadway, New York, 
My Dear Mr. Bell : 
I have yours of the 2d inst., in relation to the report of the Standing 
Committee on Hypnotism. It would give me pleasure to comply with 
your request to send my views in relation to the subject for the symposium, 
but I do not feel that I have made such a study of this question as to give 
anything that I might say any value whatever. I shall be very glad to 
learn from others. 
Very truly yours. 
JOHN F. DILLON. 
Ex-Judge T. J. Barnett writes : 
Fordham Heights, February, 1891. 
Mv Dear Mr. Bell : 
Perhaps you think that you compliment me when you ask me, as you 
do, to write on the law side of Hypnotism. But how can I—unless my- 
self suggestively hypnotized by some mystic—when there are no sufficient 
facts in the case before me ? Thus submitted to me on its face, you must 
go out on demurrer, for want of a sufficient presentation. However, I 
will talk a little obiter dicta. HYPNOTISM AND THE LAW. 
11 
As poor Mr. Lincoln (dear Mr. Lincoln) said to Horace Greeley about 
the late war between the North and the South, so say I about what I hear 
and read, but see not, in any part, wholly proven, on the subject of hyp- 
notism, viz.: “ It’s a big thing.” The thing itself, in some form or other, 
is as old as tradition, floating ever nebulously in the air, doing much 
queer work of all sorts, Satanic and otherwise. It did a good and a perti- 
nent thing, however, when it materialized the ghost of Hamlet’s father, 
when, clad in complete steel, that spirit opened the ponderous doors of 
its sepulture, revisited the glimpses of the moon, made night hideous and 
Hamlet crazy, and wrung from the dazed prince its solution, to his own 
mind, viz.: “ There are more things in heaven and earth than are dreamed 
of in your philosophy,” or words to that effect. In other words, Hamlet 
then, was about where we are now in this quest. 
Whatever is against the public morals or the public health is illegal by 
the Common Law. If, however, this hypnotism has assumed a new phase, 
demanding special legislation for the protection of its good uses (newly 
developed), as a medical factor, and against such perversion of this phe- 
nomenal power as makes it dangerous and even beastly in unskilled or vile 
hands, clearly herein is very serious work to do by your Medico-Legal 
Society. 
Medical science and law must go into very close, patient, and diligent 
companionship herein and make a case, as well for the good as for the evil 
of it, before it will be reasonable to demand for it special legislation. Al- 
ready “ the world is governed too much.” For obvious reasons legislation 
in this regard must be aided by the very essence distilled by medical sci- 
ence before it can intelligently intervene, and every lawyer must see this 
at a glance. 
If the devil be (particularly and anomalously) “let loose ” at this period, 
as a prelude to the millennium, doing crime through unconscious men by 
trance suggestion and the like, in order to secure more souls for his pleas- 
ant retreat on the Miltonic “ burning marl ” ; if, more than ordinarily, he 
be obcessing certain humanities; playing a new game which befogs M. 
D’s. and even befogging lawyers ; if, juggler-like, the cunning old rebel, 
in order to peril our souls, is throwing ropes in the air for poor mortals to 
climb up on, insisting that we shall coil the ropes after us in a mad race 
ad astra, in pursuit of the unorthodox clouds of science rather than the 
orthodox heaven of faith (just as he tempted the old fabulous chap to at- 
tempt to steal fire from the altar of the gods). Well, if this is any part of 
what is called hypnotism (and here I invite attention from Judge Noah 
Davis) in the memorable language of Bill Tweed, “ What are you going 
to do about it?” It is difficult to formulate law on a foundation of 
clouds. It is only the fair sex (bless them !) who are builded up on such 
an ever-changing basis (?) But, nous verrons; it is always the unexpected 
that happens, say our gay neighbors. 
You already must perceive that I am not about to write my few words 
very seriously (nor yet even ironically, I hope) on so grave a subject. This 
letter is designed for your festive moments, like a King’s fool at a State 
banquet. Yet there will be a little of the hypnotic in what herein follows: 12 
HYPNOTISM AND THE LAW. 
(The Meodico-TBGAi, Journal won’t be hurt at now and then infusion of, 
“ From grave to gay, From lively to severe.”) 
L,et me give an object-lesson or two, to illustrate some really demon- 
strated good results which have sprung out of hypnotism. 
For example: See our genial, suave, gentle, energetic, bright, poetic 
friend, Citizen George Francis Train. How glorious, how full of pluck, 
spring, and vivacious discourse he is, all who personally know him must 
even affectionately admit. How comfortable he and his psycho are hyp- 
notized by peanuts, baked beans, Turkish baths, long fasts, and by little 
children in the Madison Square. Mr. Train concedes not only that he is 
hypnotized, but he goes much further and declares the astounding fact 
that he is thereby privileged (and guaranteed by his psycho hypnotizer) 
to exist in the flesh, on this planet, in vigor and youth, for two centuries 
yet to come. Surely this is what they call a ‘‘crusher ”—for what hope 
has our medical science, with existing lights only, to perform for human- 
ity a feat like this? I say, emphatically, away with a legislation that 
would interfere with Citizen Train (because of demoniac agency), or with 
his platonic demon, which is not Satan, but is, on the contrary, a benificent 
cherubic psycho. 
But I have not yet done with Citizen Train and hypnotism. I must call 
on the eminent Judge Noah Davis, to observe how herein he is entangled 
hypnotically with Citizen Train. The facts as alleged by our friend Train 
present an interesting cause for possible hypnotic law: 
It is an open secret (on all fit occasions Mr. Train avows it; indeed he 
has said it in the public journals) that the eminent Judge aboved named, 
many years ago, judicially pronounced the said citizen to be a (‘‘ mild ” ) 
lunatic, in which status—so far as T have examined the record—the said 
citizen now remains. Dating from said judgment the said Train’s condi- 
tion, in so far as it regards property, has been and is that of an ‘‘irrespon- 
sible.” He is a ward in chancery. Now, pending this trance condition, 
defined by the judge, and so adjudicated, to be “ mild lunacy,” (as “ Citi- 
zen Train ” alleges) property of immense value, estimated at millions, has 
passed out of the Citizen’s hands, sold for taxes or on liens during Citizen 
George’s hypnotic trance, which the judge so hazardously affirmed to be 
mild lunacy (hypnotism at that time being an unknown factor.) Query : 
When the citizen shall waken from his trance, if at any period during the 
lifetime of Judge Davis, will not the Judge be personally liable to recoup 
his hypnotee—by him hypnotised by virtue of the adjudication which 
put the Citizen into this trance-state? This is a point, sir, and fit for 
‘‘Contingent Remainders.” It is perhaps, however, not very clearly put, 
but who shall say that it is not hypnotic ? 
I think it is Bulwer, who somewhere says : “It would be a great thing 
if the magnetizer could get me out of my own skin and into somebody 
else’s ! ” What do our specialists—the noble army of dermatologists— 
say to that, as a possible hypnotic factor in physic ? In the comparison 
with this easy possibility, what do your microscopes, lymphs, caustics, 
unguents, knives, with which you arm yourselves in the bacilli-microbe- 
hunt, amount to in the way of treating those persistent, tedious skin dis- 13 
HYPNOTISM AND THE LAW. 
eases ? What is even the weight of grafting, in this scale ?—feathers to 
lend! The hypnotic-trance—the suggestion of a new skin to the victim, 
—and presto, the work is done ! Think of this, Doctors Buckley, Fox, 
Daniel L,ewis, el at, who hunt so skillfully after your insiduous quarry in 
your renowned Skin and Cancer Hospital—wherein you are immortalizing 
your work, and erecting a monumental charity ; your doors open to all 
sects, sexes, and nationalities ; and free to such fit ones who cannot pay, 
—an asylum for incurables, until death shall relieve them—a benificence 
without endowment and wholly dependent on public charity. [I could 
not resist this episodical tribute to as pure a charity as the world has seen.] 
In view of the hypnotic skin change the veriest layman must see the long 
vista of possibilities opened by the phenomena of hypnotism. 
I know very well that Inspector Byrnes and his police will not favor this 
changing of skin hypnotism ; a new skin will hide an old rogue. And 
the practice of this art, in this way, would be manifestly unfair to the 
ladies. For, why should my young friend K run the risk of me (an 
octogenarian) masquerading through Dove’s bowers in his irresistible skin? 
And ah ! Mr. President, should thy skin be stolen ! Over such a trans- 
formation every Sorosis in this world would be draped in sable. 
Hypnotically I shall be with you at your symposium (though far away 
from you in flesh) whenever and wherever such feasts of soul and sense 
and seusuousness may be. The poet Burns (in reality) was drinking vul- 
gar beer and whiskey amidst boors in the ale houses he frequented ; but 
hypnotically he was sipping nectar and imbibing ambrosial thoughts and 
shaking with the laughter of the gods among just such a set as about you 
assemble. 
In conclusion, as I take off my cap and bells (in which I have played 
the Fool nearly to my uttermost), let me remind you gravely that it was 
Amphyction who first taught the Greeks to mix water with their wine, in 
commemoration of which circumstance they erected altars to Bacchus and 
the nymphs, on which the following epigram was founded. Knowing 
your Datiti to be so confoundedly bad I translate it (non verbutn verbo, 
however) as thus: 
“ While heavenly fire consumed the Theban dame 
A Naiad caught young Bacchus from the flame 
And dipped him burning in her purest lymph ; 
Still, still he loves the sea-maid’s crystal urn ; 
And when his native fires infuriate burn 
He bathes him in the fountain of the nymph.” 
On second thoughts I refer the original of the above to (Slat nominis 
umbra) our chaste and classic friend K . 
Ardentem ex utero Semeles lavere Lyaeum 
Naiades, extincto fulminis igne sacri, 
Cum nymphis igitur tractabilis et sine nymphi, 
Candenti rursus fulmine corripitur. ’ ’ 
Faithfully, 
T. T- BARNETT. 14 
HYPNOTISM AND THE LAW. 
The following discussion on Hypnotism took place : 
Mr. Moritz Ellinger : Mr. President—I feel very much 
interested in the thoughts expressed here to-night. We 
have to consider solely the legal views of the question. 
We could not well interfere with the medical part of it, be- 
cause, in the first place, notwithstanding many theories have 
been advanced, hypnotism is, as yet, more of a phenomenon 
than ever, studied by those who make the subject one of in- 
dividual and peculiar research. If hypnotism is practiced 
at all it should be practiced only by those who are compe- 
tent to study the subject scientifically and otherwise legally. 
Hypnotism should be applied by physicians for the purpose 
of endeavoring to affect cures. For mere experimental 
curiosity it should not be resorted to at all; not even by 
the physician ; because, though I agree that hypnotism may 
not be technically classified under the head of a disease, yet, 
nevertheless, the nervous condition of the patient who can 
be easily hypnotized is not altogether normal, because the 
normal man and woman cannot be easily hypnotized. Howr 
far that can be possible is, from a medical standpoint, very 
little known, and is more in the realm of conjecture. As far 
as the legal side is concerned I concur in the wisdom of the 
Court of Assizes in Paris in the case of Bompard, in declin- 
ing to recognize hypnotism as a factor in that case. In the 
present state of our knowledge of the subject the French 
judges gave the correct opinion. Whether the subject sought 
the operator, or the operator sought the subject, it may be 
considered mutual, and if there is a criminal responsibility, 
it rests upon both alike, and the court should not take any 
cognizance of it. 
As far as public exhibitions are concerned, they should be 
prohibited by law because the medical scientist of a modern 
city will not make a public exhibition of his skill. He will 
experiment for the purpose of bringing to light all the 15 
HYFNOTISM AND THE LAW. 
knowledge he has gained. Those people who make public 
exhibitions for the purpose of amusing the public and filling 
their pockets should be prohibited from doing so, for it is a 
dangerous practice, certainly exceedingly dangerous for 
those experimented upon. So far as the evidence in court 
is concerned, the person who claims to have acted under 
hypnotic influences would come under the same head as the 
one who claims to have acted under the influence of lunacy. 
Simply he did not act on his own nature or free will; he was 
therefore irresponsible for committing an act which the court 
considered a crime; whether the influence was violent that 
the criminal was Subjected to or that he had a diseased mind 
will make very little difference if such a plea were advanced 
in court. I think we have not advanced far enough in the 
knowledge of the science for that, and if a person put forth 
such a plea and be examined for his mental condition, the 
examination should be done by scientific persons. But I 
do not see that any law, so far as the court is concerned, is 
necessary. I do not think we are in a condition at present 
to pass different laws in regard to that spe cial phase of 
crime. Prohibit public exhibitions except by a student who 
makes it a study, and in that case only by men who are 
qualified to make these experiments. Experiments from 
curiosity or other motives should be prohibited, for great 
danger may be experienced by persons operated upon who 
may be in a perfectly normal condition and may be put prac- 
tically into a condition which would not be normal. 
IS HYPNOSIS A JUSTIFIABLE SUBJECT OF INQUIRY ? 
Dr. Wm. H. Palmer, of Providence, R. I.: Mr. Ph'esident 
—This is the pivotal question among those proposed. To 
answer it affirmatively would be to endorse hypnotic agency 
in general; while a negative answer involves a condemnation 
of hypnotism, not only for inquisitorial purposes, but for 16 
HYPNOTISM AND THE LAW. 
most other uses which it may be employed. I would, there- 
fore, preface au answer to the question by a brief consider- 
ation of the advantages to humanity involved in the use of 
hypnotism. 
The advantages claimed are (1) psychological. Here the 
claim is well founded. To the psychologist and the alienist 
the demonstration of uniform relations between mental 
phenomena and bodily conditions is important. Experi- 
ments in hypnotism certainly seem to promise to bring the 
mysterious processes whereby sensations are converted into 
ideas into a realm where they may be scientifically exam- 
ined. (When we see the face of the cataleptic assume a 
frown on his being made to double his fist as for a blow, and 
directly afterwards a smile if his fingers are placed to his 
lips as in the act to throw a kiss, we seem on the threshold 
of a revelation of some mechanical law affecting the reac- 
tions of body and mind). The phenomena of hypnotism is 
doubtless a legitimate object of scientific investigation, and 
hypnotism a justifiable agent, employed for ends tending to 
increase human knowledge and power. 
Advantages are also claimed (2) for hypnotism as a moral 
and educational agent. It is said that the depraved have 
had the habitual current of thought turned away from things 
vile by the influence of suggestions. Such cases of purely 
subjective reformation have interest, but no exceptional 
value, as similar reformations are constantly and increas- 
ingly occurring through enlightened religions, educational, 
and penal agencies, while these few and somewhat dubious 
cases of reform by suggestion are overwhelmed by the num- 
erous instances of hypnotics coerced into acts and emotions 
the reverse of elevating. 
At the present time the records of hypnotism do not 
justify its use as an agent for education or moral reform, 
for the supreme maxim of education is, “ Strengthen HYPNOTISM AND THE LAW. 
17 
good habits by accustoming the will to act promptly, and 
strengthen the will by perpetual repetitions of choices; ” or. 
from the physiological side, “Resist instability of nerve 
structure.” Hypnotism undermines each and all these 
methods by supplanting the individual will through which 
alone a permanent modification of character is possible, in 
order to make place for the domination of another’s person- 
ality. 
Advantages are claimed (3) for hypnotism as a therapeutic 
agent. We must speak guardedly here, for the relief of 
human suffering is an end which appeals to the medical 
practitioners in a way calculated to hold in abeyance 
any objections offered to measures proposed for such 
relief. 
Of the causes reported by the schools of Nancy and La 
Salpetriere, an immense majority are records of perverted 
or idiotic behavior and feeling on the part hypnotic sensi- 
tives. 
A small proportion are “cures.” These hypnotic cures, 
effected by exciting in the patient an expectation a convic- 
tion of cure, unparalleled by the cures of faith healer’s, 
“ Christian Scientists,” and the like, who also operate by 
arousing an expectation of relief. The physician also depends 
largely on expectation of cure for his success. But the ex- 
pectancy, encouraged and relied upon by the physician, 
differs in its nature from that aroused by the hypnotic or 
the empiric, in that it rests not upon a more unreasoning 
emotion, but upon a rational confidence on the part of the 
patient, that the physician’s knowledge of the healing art 
and his wisdom in applying that knowledge will accomplish 
a cure. That is, the expected result (a cure) depends in the 
patient’s mind upon a sufficient and intelligible cause (the 
physician’s skill). Or if in certain cases the confidence of 
the patient is of a purely emotional and unreasoning nature, 18 
HYPNOTISM AND THE LAW. 
then, as in the case of the empiric or the hypnotist, the 
physician’s cure is effected at the expense of the mental in- 
tegrity of the patient, for, by all known laws of mind and 
body, repeated submission to influence, uncontrolled by the 
reason and the judgment, tend to discourage self-possession, 
to impair self-control, and to increase nerve instability. 
Admitting, therefore, the possibility of hypnotic “ cures,” 
their result would be toward mental unsoundness and the 
possible transmission to posterity of inherited weaknesses 
and perversions. In hypnotic patients we should have the 
origin of another defective class; through them we should 
manufacture new forms of idiocy and alienation. For these 
general reasons I would offer a negative answer to the 
question, “Is hypnotism justifiable as an inquisitorial 
agent ? ” 
In the case of the woman Bompard, tried for the murder 
of Goufli, in Paris, the employment of hypnotism as an in- 
quisitorial agent, was denied by the Government. M. Liegeois 
asserted that if this woman was hypnotized she would give 
an accurate account of the manner in which it was perpe- 
trated. The proposal was rejected by the Government on 
the grounds “that the prisoner was a liar * * * that 
her mendacity would prevail even in the hypnotic state, and 
that shamming could not be detected.” 
Apart from the general disadvantages of the use of hypno- 
tism, the evidence does not warrant the belief at this time 
that the testimony of the hypnotic as to a committed crime 
can be accepted as evidence by which legal justice could be 
administered. The French Procurer General, on the occasion 
of the trial referred to, said: “ The consequence of that doc- 
trine (inquisitorial hypnotism, would be that there would be 
no longer any morality or any conscience. Man would not 
be distinguishable from the brute creation; he would disap- 
pear in the anarchy of unpunished crimes.” HYPNOTISM AND THE LAW. 
19 
The wave of interest in the subject of hypnotism at the 
present moment resembles waves of interest in other occult 
influences, such as possession by devils or witchcraft, mes- 
merism, spiritualism, etc., which have from time to time 
flowed into the current of human thought, and have ebbed 
again into the great ocean whence they came, leaving no 
permanent additions to human knowledge or power to mark 
their track. 
Mr. Wilson McDonald: Mr. President—It has been 
nearly fifty years since I first witnessed experiments in mes- 
merism and idependent clairvoyance. Up to the present 
time I have not known or heard of a case which resulted 
fatally or even injuriously to either a subject or a patient. 
But, on the contrary, I have known a large number of cases 
where pain has been instantly removed, patients cured, sur- 
gical operations performed without pain, lost articles found 
and restored, business complications adjusted, warnings of 
disasters that were to come foretold, and, in many instances, 
good and permanent results experienced by persons who had 
been mesmerized. The proposition, therefore, to enact laws 
in the State of New York to prevent mesmeric experiments, 
or place them exclusively in the hands of the physicians, is 
not only unwise, but absurd, and shows conclusively, to my 
mind at least, that the proposers of such a course, regarding 
this interesting phenomena, know little or nothing about it. 
There are no facts showing that physicians are any more 
capable of investigating the phenomena than any other class 
of citizens. The ability to mesmerize or demesmerize a sub- 
ject depends more on the physical, mental, and nervous or- 
ganization of the mesmerizer than it does on the profession 
which he may follow. 
The laws that seem to control what has lately been called 
the hypnotic condition are as yet but little known. 
I am unable to understand why and by what authority the 20 
HYPNOTISM AND THE LAW. 
word hypnotism has been substituted for the word mesmer- 
ism. This latter word has been in use for an hundred years 
and was always clearly understood. Was it because the 
term was an unpopular one; or was the word hypnotism 
substituted as a sort of a shield to investigation against 
popular and ignorant clamor ? Be this as it may, it was only 
after nearly a half century of discussion and contention by 
the “ Forty immortals ” that the main facts of mesmerism and 
clairvoyance were adopted by the French Academy. This 
goes to show, to some extent, that which has often been 
claimed, id est, that scientists have generally been the first 
to oppose nearly all the great discoveries and the last to 
acknowledge them, even after they had been demonstrated! 
I hope no law will ever be placed upon our statute books 
abridging the right of honest investigation of either known 
or unknown laws of nature. 
Dr. Henry S. Drayton : I would simply remark, in re- 
sponse to your naming me, Mr. President, that I am inclined 
to take similar ground with Mr. Wilson MacDanald, although 
I should refrain from being quite so radical in terms. In 
considering this subject from a legal point of view, it is nec- 
essary to be sure first of its scientific grounds, and so to 
have provided a definite premise or proposition that would 
give a fair and logical synopsis of the subject. As the fact 
is, we have yet to find in any of the discussions a definite 
account of what hypnotism is, and feel warranted in the 
claim that scientific men, whether of the legal or medical 
school, are not fully qualified for considering the subject. 
I have read the views of Professor Heidenhiem, Dr. Bern- 
lieim, and of Professor James, of Harvard, and find that they 
hold very different opinions, and it is found that all those 
who have taken up hypnotism and studied it carefully are, 
as a rule, frank in acknowledging that it presents phenomena 
involving much obscurity. I am inclined to take the ground, HYPNOTISM AND THE LAW. 
21 
with Dr. Timing, that hypnotism per se is not injurious as a 
mental experience, and speaking as one who has employed 
hypnotism medically and experimentally I do not look upon 
it as a phenomena so abnormal as to lead to injurious ef- 
fects, unless improperly employed. I should regard hyp- 
notism as any other extraordinary thing should be regarded, 
as a matter to be investigated, and its merits, whatever they 
may be, should receive due appreciation. In one of the 
English reviews an article was published recently in which 
the writer discusses the legal and moral aspects of the sub- 
ject we are now interested in. He puts it that the law 
should not intervene to prohibit experiments in this regard 
any more than it should prohibit experiments, by competent 
persons, in vivisection. Discrimination should be exercised 
in this matter, and any step taken by judicial authority 
should be the result of deliberate and intelligent considera- 
tion of the whole subject. 
Mr. Julian Hawthorne: Mr. Pi'esident—I came here to- 
night with the hope of adding to my professional views. My 
position is a little difficult. I suppose it is something new 
in the Medico-Legal Society to be addressed by a person 
whose ignorance of law is only exceeded by his ignorance of 
medicine. It is the method of poets and scholars that they 
should be true to their types and meet these sudden de- 
mands upon them. 
It may be that even science is not yet fully conversant 
with the phenomena, and where ignorant men might not 
hesitate, scientific men would fear to enter, and it would 
thus deter them from giving forth their views. I might take 
up the literary part of the matter, but to do that I should be 
obliged to rehearse the stories I have written or give away 
the stories I have yet to write. The truth is, my chief em- 
barrassment arises from the fact of having nothing of con- 
sequence to say. I find my individual opinions so conflict- 22 
HYPNOTISM AND THE LAW. 
ing and so contrary in themselves that it is difficult to adopt 
a decided line. I think I shall, with your permission, con- 
sider some of those conclusions which your committee re- 
garded as established facts which so frequently happen. I 
am unacquainted with the steps by which this decision was 
reached, but I am inclined to think that hypnotism is as 
much affected by something transferred from the operator as 
by anything produced by or from the subject. No man can 
meet another man’s thoughts; the thoughts that are trans- 
cribed by himself, without something emanating from it, 
some mutual influence which continues as long as though 
made by association. The influence used by the liypnotizer 
on his subject is something of that kind. It is perfectly 
true that the hypnotized person may hypnotize himself. 
That opens an interesting view of the subject which five min- 
utes is fully inadequate to discuss. You all know the case 
of the woman who had three hypnotic states ; the deepest 
was the first, the second was that of a stupid peasant woman; 
the third, an hysterical, lying, scheming person, who realized 
enough of the hypnotic state to try and hide the fact that 
her normal state was controlled by it, the latter trait being 
that of a person of strong character. 
It leads to the fact that hypnotism is not natural, as 
Hiedenlieim supposes, but is a metamorphose of most of the 
intellectual faculties. The great orator who gets up to make 
a speech and forgets his ego is hypnotized, especially when 
he is at his best. Let an experienced after-dinner speaker 
rise before a company to speak. The moment he gets on 
his feet he encounters his ego, and being unable to control it, 
he is at once plunged into mental misery, and his speech is a 
failure. The great poets and actors are self-hypnotized, and 
in their hypnotic state liberate their higher powers. The 
great Henry Clay had a story told about him when he once 
started to speak, and when in full tide of his oratory forgot Associate Justice Supreme Court of Texas. 
HON. R. R. GAINES, HYPNOTISM AND THE LAW. 
23 
himself, and nearly always sat down completely exhausted. 
So one night when he was about to speak he told a friend to 
stop him after five minutes. The friend allowed him to 
speak ten, then pulled his coat tails, but Clay paid no atten- 
tion. Then after fifteen minutes he stuck a pin into him, 
and continued to do so at intervals for an hour and a half, 
when Clay sat down utterly exhausted, and completely ob- 
livious to what his friend had been doing, he said, “ Have I 
not spoken more than five minutes ? ” His friend said, “ You 
have been speaking for an hour and a half.” “ Why did 
you not stop me ? ” Then his friend told him what he had 
done. 
I wish to say, in regard to the actual questions which are 
asked in the report to the Society, I should be entirely op- 
posed to any legal interference with hypnotism or its inves- 
tigation. If I were a dictator I should insist that hypnotism 
should be practiced in every family, by all the members, at 
certain times each day for one year, and at the end of that 
period my dictatorship would be ended and nothing would 
be heard of hypnotism for the next hundred years. 
Dr. Paul Gibier : Mr. President—I beg you to pardon 
my inability to speak the English language. I told you I 
could not talk on the subject, although I was perfectly will- 
ing to come and listen to the interesting communications 
which are being made, but I feel entirely unable to speak on 
the matter. You have known that I have studied the phe- 
nomena of hypnotism with Prof. Charcot in Paris. For my 
own satisfaction I have studied this science, but I tell you if 
I had power to prevent it, I would not let you know that I 
have written on this subject, which I consider as a very dan- 
gerous and compromising one. At present I indulge only in 
the field of microbes. The microbes and hypnotism do not 
seem to be very well acquainted, but perhaps between mi- 
crobes and hypnotism the distance is not so long or so far 24 
HYPNOTISM AND THE LAW. 
as one would think : when you are promoting the phenomena 
of hypnotism you are studying the phenomena of life. 
Microbes are, so to speak, the beginning of life. As for the 
former, I think that if you care for the interest of the indi- 
vidual, it would be wise to prohibit public exhibitions of 
hypnotism; but if we consider the principle, we can lay aside 
the theory of prohibiting public seances. Out of a thousand 
experiments, one may be injurious and the rest harmless. I 
know that in Paris I attended many meetings of mesmerists, 
liypnotizers, and spiritualists. I have seen many poor ex- 
hibitions; I have seen also many wonderful effects, and 
remarkable things done, and in thus allowing public exhibi- 
tions, we might some day see some interesting develop- 
ment. Thus public exhibitions will become a little more 
frequent, as they are in parts of Europe. The matter is very 
hard to settle, and those who have indulged in experiments 
know how difficult it is to find good hypnotic subjects. I do 
not feel quite free, for personal considerations, to give 
extended views on this subject, which I have carefully 
studied. I, at present, prefer to listen and to learn rather 
than to advise and to speak on this deep and interesting 
matter, in which I foresee the solution of many a problem of 
the science of life—past, present, and future. 
Dn. E. P. Thwing : The subject covers a wide continent 
of thought. Is hypnosis a neuropathic condition ? Does it 
involve a lack or loss of integrity in cerebral structure or 
function ? Is its proper induction at all perilous to the gen- 
eral nervous system ? Does the will become less resolute, or 
can it be invigorated and mental perversities corrected ? 
Can physical disabilities, as well as neurotic troubles, be 
alleviated ? A multitude of such questions occur to the 
physician. But when we look at the juridic aspects, the 
field broadens. It is worth our while candidly to canvass 
them. HYPNOTISM AND THE LAW. 
25 
At the outset we are confronted by two divergent tenden- 
cies, the one leading to exaggeration, the other leading men 
to belittle, disparage, and ignore the matter. Of the former, 
we have illustrations in recent criminal trials here and in 
France, where ingenious but happily ineffective efforts have 
been made to disguise or deny criminal intent by assuming 
that the accused was irresponsible, because susceptible to 
psychic control. On the other hand, some intelligent people, 
including physicians, relegate the facts of hypnotism to the 
same category of delusions as Perkins’ tractors and the 
waters of Loudre. A still larger number admit the facts, but 
advise their concealment. Ostrich-like, seeing danger, they 
would bury their brains less they suffer harm, ignore the 
force lest some one might pervert it. Assuming, however, 
freedom from these extremes of indocility and exaggeration, 
what may be considered as fairly settled ? 
1. That this dreamy state is not necessarily a disease. 
That neurotic conditions predispose one to it is admitted. 
But those possessed of the finest minds have juelded, and 
their experiences from the days of Hippocrates till now 
have been recorded. Dr. William Smith, in his Bible Dic- 
tionary, says that “ many, if not most of those who have left 
the stamp of their own character on the religious history 
of mankind, have been liable to pass into this abnormal 
state.” 
2. It is equally true that the results need not be harmful. 
The lamented Dr. George M. Beard, whose experimental 
acquaintance was so wide and thorough, speaks strongly of 
the advantages, and under my own observations the most 
gratifying results have been reached, and unsolicited testi- 
monies have been given as to the value of hypnosis in gen- 
eral therapeusis and in minor surgery, where not only pain 
has been abolished, but that prescient fear of pain which 
equally devitalizes the nervous system. 26 
HYPNOTISM AND THE LAW. 
4. Hallucinations created may be made to continue for 
weeks, at least, afterwards, and so to tyrannize subsequent 
actions. This is one form of emotional insanity frequently 
seen in common life in what is called infatuation. A con- 
tinuous subjugation of one’s will to another, continuous per- 
versions of moral, visual, or tactile impressions may unhinge 
one’s faculties. Therefore— 
5. Legal supervision of the matter is timely and proper. 
Recent interdictions by boards of health of the performances 
of traveling operators in this line of business were legitimate. 
In some cases the society for protecting animals against 
cruelty might well have interfered. 
6. The use of this condition as an inquisitorial agent is 
not justifiable. No revision of the penal code seems called 
for at present. These and other points are consid- 
ered in a paper read before this body April 10, 1889, 
which appeared in its journal, and, therefore, need no ampli- 
fication.” 
These replies, and the replies sent from those close at hand 
before the February session, will seek to open the discussion 
of the legal aspects of hypnotism, and awake, as I hope, 
responses from the students of the science in Europe, and 
indeed in all foreign countries. 
My object in thus bringing these eminent scientists to 
speak on a topic of such public interest at the present time, 
and which I am surprised to see is mainly outside the medi- 
cal profession in this country, was to call attention to the 
labors of our standing committee, and to invite views from 
all students of the science everywhere, and I shall forward 
this paper to such men of science as I know take an interest 
in this study, to elicit their replies to the legal propositions, 
so forcibly presented in the report, from which I enclose the 
propositions under discussion. HYPNOTISM AND THE LAW. 
27 
I quite agree with Prof. Jastrow as to the unwisdom of 
limiting its use to physicians in any restrictive legislation, 
and if Prof. Church correctly reproduces the action of the 
Medico-Legal Society of Chicago, as recommendiug “ that 
its use be limited under penalty to properly qualified medi- 
cal men,” I could not bring myself to consent to such legis- 
lation. 
As a rule, physicians know next to nothing concerning it, 
especially in New York City. In Chicago it may be differ- 
ent, but here I would not be able to name more than half a 
dozen who have investigated it. 
Those men of science in this country who have studied it, 
aside from the well-known names of Beard,W. A. Hammond, 
Prof. E. P. Tliwing, C. H. Hughes, and not half a score 
in all, are rather students of science than doctors of medi- 
cine. 
There is great force in Prof. James’s broader vision of the 
true relation of scientific inquiry to the lawrs. The legal 
aspects of the question are upon us. The Bar and the 
Judiciary are in duty bound to carefully and calmly investi- 
gate, and, so far as possible, define the phenomena, and place 
its true limitations regarding personal and, certainly, crim- 
inal responsibility. 
There is ten-fold more interest and desire for thorough 
examination in this country among laymen of all classes at 
the present moment than among medical men in America. 
This is not likely to remain so. Medical men who once 
grapple with this question will be its most successful ex- 
plorers, for the reason that they have greater facilities, and 
should be more nearly related to that branch of medical 
science touching on neurological, mental, and psychiatrical 
studies. The lustrous names in science of the French 
schools to whom I have alluded, and the brilliant galaxy of 
names upon the staff of la Revue de-1 ’Hypnotisme of Paris, 28 
HYPNOTISM AND THE LAW. 
of Hack Tuke in England, of W. W. Ireland in Scotland, of 
Dr. Norman Kerr, who assails it, of Krafft, Ebing and Korn- 
feld in Austria, and the men of science in Belgium, Italy, 
Spain, Germany, and the Dutch, Russian, and Scandinavian 
countries now engaged in these studies, make it impossible 
for men of science in America to ignore it. 
If this paper shall have aroused any interest in the prob- 
lems which the report of the committee now presents, I shall 
feel amply repaid for the space allotted to the topic in the 
present issue of this Journal. NATIONAL AND STATE CHEMISTS IN THE 
COURTS OF LAW.* 
BY CLARK BELL, ESQ., PRESIDENT OF THE MEDICO-LEGAL SOCIETY 
OF NEW YORK. 
CHEMISTRY. 
Chemistry stands as a base, as a foundation and corner- 
stone for nearly all science; on it rests most of the scientific 
research of our era. 
In medicine it lies at the very root. A chemist need not 
be, and the great chemist doubtless ought not to be, a physi- 
cian. But no physician should dare to enter even the por- 
tals of the temple of medicine without bathing in the waters 
and acquiring the mysteries of chemistry. 
Chemistry seems to my eyes to be not unlike the angel 
who rolled the stone away from the sepulchre two thousand 
years ago, revealing those mysteries which the faithful see 
in the resurrection, aud opening the door and way for the 
light to come forth. 
Chemistry is the prolific mother of all the world’s wealth. 
The earth is her treasure house, the sea her hand-maiden, 
the air and fire her willing servants, who come at her beck, 
and go at her nod. 
Steam and heat are only too happy to bear her bur- 
dens, and light and electricity are her swift-winged mes- 
*Read before the American Chemical Society, December 31, 1890, at 
Philadelphia. Read before the Medico-Legal Society, February 11, 1891. 30 
NATIONAL AND STATE CHEMISTS IN COURTS OF LAW. 
sengers. Her students and votaries live in that charmed 
life and atmosphere, in which she envelopes her mys- 
teries. 
To her there is nothing new, but she withdraws the veil 
which obscures human vision in our century, to her favor- 
ites little by little, as to secrets, that she may have blazoned 
at noonday, in the prehistoric times, to the priests, who 
then kept up the sacred fires upon the altars, within her 
temples. 
To-day she tells us, by the spectroscope, the organic con- 
stitution of the sun, and speculates upon the gases, and 
incomparable heat of fires, at the center of our solar system, 
which we see reflected in the organism of the myriads of the 
fixed stars. 
She is greater than fortune, for all the known gems of 
the Avorld do not equal the contents of a single cabinet, 
in any one of thousands of apartments in her treasure 
house. 
She has unfolded to our era many of her old truths, 
which touch on the life, health, and happiness of mankind, 
and which lie underneath all the commerce, the industries, 
and the arts of the world, and touch on every side the civil- 
ization of the age. 
She holds the key to all the chambers of knowledge 
now sealed to our vision, and it is to her we look, within 
the next century, for the advancing steps of a higher 
civilization, depending upon her caprice as to how much 
farther she may put aside that impenetrable curtain, 
which conceals and hides the unknown and unattainable. 
When she speaks as a witness in the tribunals, where life 
and death and character are in the balance, she is always 
voiceless, unless absolutely infallible. 
If she does not demonstrate beyond question, or cavil, or 
doubt, she should be silent. NATIONAL AND STATE CHEMISTS IN COURTS OF LAW. 
31 
The light from her lamp must be clear, certain, unerring, 
true, exact, and unquestionable. 
She deals not in suspicion, not in conjecture. If in 
doubt, her evidence must not be taken, nor her voice 
heard. 
If the poison is found, if the analysis detects it, if all 
proper precautions are taken, and the facts remain, then her 
voice is inexorable because it is truth. It is the voice of 
nature, the voice of the Infinite. 
This highest evidence, this light which science throws 
upon the labors of the courts, in the administration of jus- 
tice, deserves in our States that careful recognition which 
exists in many other countries of the world. 
We need such a man at the service of the nation as Dr. 
Thomas Stevenson is to the Government of Great Brit- 
ain, who succeeds that eminent man, Dr. R,. Swayne Taylor. 
We need such a man here as Brouardel is to France, and 
as the great Orfila was to his own country. 
Such a laboratory at Washington, with one of our best 
chemists at its head, would advance the study of the 
science incomparably beyond our present ideas and plans. 
It would be the centre of all the schools, for the study of 
the science, both at the National Capital and in the States, 
worthy the nation, and worthy the science. 
The administration of justice in criminal trials, notably 
in cases of alleged or suspected poisoning, deserves the 
thoughtful attention of jurists, publicists, and legislators. 
The duty lies upon every human government organized 
for the full protection of society, to take every step in its 
power, as well to trace and detect the prisoner, as to defend 
the innocent unjustly accused or suspected. 
So far as human punishments go, there is nothing the 
guilty can suffer, short of actual death, more terrible than 32 
NATIONAL AND STATE CHEMISTS IN COURTS OF LAW. 
that which the innocent endures, who rests through life un- 
der the general and apparently well grounded suspicion and 
belief of guilt. 
The problem in these cases usually is: Was poison ad- 
ministered by the accused ? And all will agree with the 
wisdom of the legal maxim, “ Better ten guilty ones escape 
than one innocent suffer.” 
Cruel as is the fate of the innocent unjustly accused, 
wrongfully suspected, and resting through life under the 
suspicion of guilt, it does not touch upon the borders even 
of that terrible despair endured by the innocent one wrong- 
fully committed and condemned who suffers the extreme 
penalty of the law. 
In a government like that of the United States of America, 
composed of several States, united as a whole, where the 
State authorities assume the responsibility for all cases, ex- 
cept such as belong exclusively to the jurisdiction of the 
general government, the responsibility is divided between 
Congress (whose duty is clear in cases within the national 
jurisdiction as to the trial and punishment of offenders 
under and against the laws of the nation) and the legisla- 
tures of the States, for offences committed against State 
laws. 
The American Union, however, is the guardian, protector, 
and foster-mother of all the people of all the States, and 
has the power, the right, and should be quick to assume the 
duty, of enhancing the public good, even though the effects 
and beneficial results fell mainly on the poor, the wretched, 
and lowly. 
Every criminal judge, prosecuting attorney, and more 
especially every counsel for the prisoner, in this class of 
cases, acutely feels, the great public need of skilled and 
competent chemical advice in such cases—advice 
based upon the most careful analysis, the most critical HON. JOHN P. WHITE, 
Presiding Judge. 
HON. JAMES M. HURT, 
Associate Judge. 
HON. W. L. DAVIDSON. 
Associate Judge. 
TEXAS COURT OF APPEALS. NATIONAL AND STATE CHEMISTS IN COUKTS OF LAW. 
33 
and crucial tests, with the aid of every appliance known to 
chemical science. 
Every consideration binds our judgment to the decision 
that this advice should be unbiased, impartial, clear, able, 
and convincing. 
The accused, if poor, under our system is absolutely power- 
less to obtain this evidence. 
The Government, if bound to protect the innocent, has 
taken no steps to discharge its obligation. 
The duty to provide a national chemist is too plain to be 
even challenged. 
It cannot for one moment be denied. 
The only question is, or should be, how can Congress for 
the nation, and the Legislature for the States, best meet this 
issue and discharge this obligation? 
The cost of a careful and elaborate chemical analysis in a 
poisoning case, where the accused is poor and friendless, is 
so great that our present system is a practical miscarriage of 
or denial of justice, when the poor, though innocent, stand 
accused. 
We submit that the plain duty of Congress is to create and 
designate a public official, to be called the chemist of the 
nation, whose duty should be, by his oath of office, to con- 
duct all such investigations, as a careful searcher after the 
truth, as well for the accused as for the people. 
The salary should, of course, be sufficient to command the 
highest talent in the nation, and the laboratory should be so 
equipped as to reflect credit on our Government for its com- 
pleteness, in every respect, known to the student of chemis- 
try or in contrast with any laboratory in the world. 
For the States, it is on too low a plane to discuss such a 
question as this, in its relation to the whole people of a 
State, and to oppose such a measure in a State upon the only 
possible foreseen ground, that of its cost. 34 
NATIONAL AND STATE CHEMISTS IN COURTS OF LAW. 
If any State in the American Union is so small, or so poor, 
as to gravely weigh the cost against public honor and duty, 
it should consider how it could meet its obligation, by obtain- 
ing the aid of a sister State by suitable legislation. 
A select committee of the Medico-Legal Society has been 
considering the subject of recommendations I had the honor 
to make to that body, and I ask the co-operation of the 
national association of the chemists of America in a move- 
ment so intimately connected with the honor and dignity of 
the profession you represent and so closely connected with 
the rights and protection of the people of this country. 
NOTE.—The report of the majority of the Select Committee of the 
Medico-Legal Society made a report favoring such an officer in the nation 
and also in the several States, at the February meeting of 1891, which was 
unanimously adopted by the Society at that session.—Editor. HON. CLINTON McKAMY WINKLER, 
HON. GEORGE CLARK. \ 
EX-JUDGES TEXAS COURT OF APPEALS. 
HON. SAMUEL A. WILSON. MECHANICAL RESTRANT IN THE CARE 
AND TREATMENT OF THE INSANE. 
When Pinel struck off the chains and manacles that res- 
trained the insane at the Bicetre, in Paris, in the days of the 
French Kevolution, he grievously offended the Superinten- 
dents of the Asylums of France, in depriving them of the 
right of exercising their discretion as to restraining the 
insane patients, either for their own good or from doing 
bodily injury to others. 
It is not probable that many medical men in France in 
charge of the insane believed it possible to keep these unfor- 
tunates safely without the bonds, which this eccentric, but 
wise and far-seeing, enthusiast, broke into pieces never to be 
again riveted upon the limbs of Frenchmen. 
Recently France placed his statue in her chief city, to 
commemorate an act and life which should have canonized 
him, if relief from needless human suffering is a virtue, and 
of beneficence to the race. 
The scales that fell from the eyes of those who deemed 
these safeguards absolutely necessary for the personal safety 
of keepers and the good of the afflicted, weighed equal in 
that eternal balance which in its other cup held the broken 
shackles declared no longer necessary in the insane asylums 
of France. 
Guislain broke the same magnificent truth to Belgium 
when he inaugurated the doctrine that bonds, manacles, and 
restraints were not the royal roads or means by which the 
“mind diseased” could be brought back to sanity, and that 
these were not the true methods for the proper care and 
treatment of the insane. 36 
mechanical restraint in the 
The labors of the elder Tuke, followed by grand John 
Conolly, inaugurated that crusade against the horrible 
abuses of the insane in Great Britain, which the Earl of 
Shaftesbury so vividly described in his earlier labors, and 
which he lived long enough to see banished from British 
asylums by universal popular acclaim. 
While these grand and noble reformers were marching 
with splendid upward strides on the eastern shores of the 
Atlantic, the American leaders of Alienistic thought and 
progress seemed ignorant of this enormous revolution in 
mental medicine abroad, and the atrocities, barbarities, and 
abuses of the helpless and defenceless insane went on here, 
almost without hope of relief or remedy. 
I have seen, in an almshouse in this State of New York, a 
naked woman, confined in a dark room, without light, with a 
grating for a door, without bed or clothing, sleeping on 
straw alone, in all ways treated like a wild beast, which she 
of course in her condition much resembled, lying in her own 
ordure, and this not so very long ago, and the Superintend- 
ent of that asylum, in common with Superintendents of the 
other American asylums where restraints were used, believed 
all these terrible restraints and appliances were indispensi- 
bly necessary, and would have so sworn in a court of justice, 
with a free conscience. 
Dr. Alice Bennett, Superintendent of the Pennsylvania 
State Hospital for the Insane, at Norristown, told me that 
when the Philadelphia Almshouse burned a few years since 
and she offered asylum to some of the women who had been 
inmates, they were sent to her chained at the legs, like crimi- 
nals! 
But, gradually, came in recent days the silent growth of a 
bloodless revolution of thought, that, like the trade winds, 
blew westward from England, France, and Belgium across 
the Atlantic—that new doctrine of Pinel, of the elder CARE AND TREATMENT OF THE INSANE. 
37 
Tuke, of Guislain, and of Conolly—that the insane were 
men and women of human flesh and blood, and that kindness 
and tenderness, love and affection, were stronger and more 
efficacious with them than even bands of iron or hoops of 
steel. 
And soon came out of the darkness, American Superinten- 
dents, one after another, who, reared under the old teach- 
ing, and filled with other traditions, imbued with their Anglo- 
Saxon hate and distrust of change and the introduction of 
new ideas, determined to try and see if the insane needed 
chains or bonds or muffs or camisoles, and who having tried, 
tasted, aud succeeded, strove on until they stepped up into 
the bright, eternal, and shining light of the grand truth that 
restraint was not necessary at all. 
Englishmen like D. Hack Tuke and George H. Savage, 
who knew the high standard of British asylums, could not 
have dreamed of the existence in our own day of such abuses 
as existed here, and as the former found at Longue Point 
Asylum, in Canada, and in other quarters, which are now, 
thank God, fast disappearing. 
Onward swept the current of reform, long delayed by that 
sturdy fighter, Dr. Gray, of Utica Asylum, who, with his 
strong personality, kept New York lagging in the rear of the 
movement, until, at his death (timely for this reform), his 
cribs and other appliances were swept away by an irresist- 
ible impulse and current, that brought the New York State 
Hospitals, almost at a bound, into the front rank, under the 
impulse given by Dr. G. Alder Blumer, the pupil, but not 
in this respect the disciple of Gray, into a practical abolition 
of mechanical restraints, which had hither to been almost 
universal and are now almost wholly abandoned in the Em- 
pire State. 
There are those who, surviving a great revolution, see not 
its results. They are blind to what all else see, and, like 38 
MECHANICAL RESTRAINT IN THE 
Epliraim, are joined to tlieir idols, and should, like him, often 
be left alone. Such are those scattered men who, here and 
there standing alone, and surveying the field that has been 
swept by the deluge of advancing thought, are oblivious and 
unconscious of what has has been carried off by the flood. 
They stand where their fathers and grandfathers stood, and 
they use the restraints they learned to use in their youth and 
practiced in their middle life, and, having ears, hear not 
the rushing of the waters, and eyes, see not the effulgence of 
the light that has come in after the deluge, and with its 
beneficent rays illumined all the landscape of scientific 
thought and progress. 
Dr. Henry Maudsley, once, dining with me at my club 
in New York, related an anecdote of a physician from a pri- 
vate asylum calling on him to see if he could borrow a cami- 
sole for an experimental trial, and how indignantly Mauds- 
ley demanded some justification for his thus imagining 
for a moment that he would have such an implement in his 
place, and Dr, Maudsley stated to me on that occasion that 
he never used a camisole in his life. 
Dr. Peter Bryce, one of the ablest of American alienists 
of our generation, a pioneer in the American reform move- 
ment of non-restraint, in his last annual report made his 
usual announcement of the success that had crowned their 
efforts for ten years in the Alabama State Hospital, where 
there had been, in a household of an average of 1,000 
patients, no resort whatever to any species of mechanical 
restraints for either surgical or other purpose, and using this 
remarkable language: 
“Not a vestige of restraining apparatus of any kind is to 
be found about the premises, nor has there occurred a single 
case in the wards of the Hospital during this long period 
which seemed to justify or require its use.” care and treatment of the insane. 
39 
This extract from his report was published in the Medico- 
Legal Journal, Yol. 8, page 311, (March number, 1891.) 
The same number of the Journal contained editorial com- 
ments upon Dr. Bryce’s report (P. 373), making the conten- 
tion : 
1. That the fact that non-restraint had been so successfully 
and so long practiced at such asylums as the Alabama State 
Hospital, under Dr. Bryce ; the Pennsylvania State Hospital 
for Insane Women, at Norristown, Pa., under Dr. Alice 
Bennett; the New York Asylum for Insane at Willard, under 
Dr. P. M. Wise for so many years, and since under his 
successor, Dr. Charles W. Pilgrim; at St. Ann, Paris, 
under Dr. Magnan ; at Broadmoor Criminal Asylum, under 
Dr. William Orange, and his gifted successor and pupil, 
Dr. Daniel Nicholson had demonstrated that mechanical 
restraints could no longer be claimed to be even necessary, 
much less indispensably so, and— 
2. That the claim that “ a superintendent should have the 
right to resort to mechanical restraints only in extraordinary 
cases, and when all else fails” should be conceded, and as a 
consequence the whole question relegated “to the discretion 
of the Superintendent,” was both unsafe and fallacious; be- 
cause— 
(a.) In Pinels’ time what was done was under precisely such 
a discretion, and the same was true in Conolly’s day, and in 
every asylum in the world where it is now practiced, the 
Superintendent is usually sincere and fairly honest in be- 
lieving it to be necessary, and— 
(b.) That it retarded recoveries, and inflamed and outraged 
the patient so as to put him in grave dangers, and converted 
asylums into a pandemonium, as asylums frequently are 
where it is practiced, and— 
(c.) A comment upon recent utterances of distinguished 
English alienists which had been quoted to sustain prac- 40 
MECHANICAL RESTRAINT IN THE 
tices and abuses that would not have been countenanced for 
a moment in British asylums. 
These publications led Dr. Theo. Diller, of Pittsburgh, 
Pa., to ask the publication of a paper taking the opposite 
views. The Medico-Legal Journal is not willing to reject 
the opinions and views of those who differ from its editor, 
and Dr. Diller’s paper is given, as well those of other gentle- 
men qualified to speak on this subject on both sides of the 
contention. The paper of Dr. Diller is given: 
To the Editor of the Medico-Legal Journal: 
Sir:—It is to be feared that many who advocate entire 
non-restraint of the insane take this position not so much 
because they believe it to be right, as they believe this posi- 
tion to be politic. They know full well that among well- 
meaning philanthropists who have no practical experience in 
dealing with the insane the statement that “no restraint 
whatever is used ” will be hailed with great applause. 
Seemingly they are far ahead of their brethren who advocate 
“judicious restraint,” and accordingly they receive greater 
eclat. In my opinion the “entire non-restraint” men do not 
really treat their patients as kindly as the “judicious res- 
traint” men. This latter class, it must be remembered, is a 
long-suffering one. It is no small matter for men like Savage 
and Hack Tuke, who are among the most humane and pro- 
gressive of the Superintendents, to be continually having in- 
sinuations and innuendoes cast upon them by their hyper- 
righteous “absolute non-restraint” brethren. It is bad 
enough to intimate that the “judicious restraint” men have 
less tact and judgment than the “non-restraint” men; but to 
charge them with being less humane is going much too far. 
Drs. Hack Tuke and Savage restrain patients who, if 
they were under the care of Drs. Bryce and Wise, would not 
be restrained—for certainly Wise and Bryce must handle the 
same kind of patients that Tuke and Savage do. Now, is it CARE AND TREATMENT OF THE INSANE. 
41 
fair to infer that these patients, who were restrained, would 
have been better off had they not been restrained? I 
answer, most probably no; but on the contrary they were 
better off for being restrained. They were more humanely 
treated. 
Let us suppose that Dr. Savage restrains a patient suffer- 
ing from that most terrible of all forms of insanity, acute 
delirious mania; another one in the violent fury of post-epi- 
leptic excitement; another (a paranoic), who would terribly 
mutilate his body in obedience to imperative conceptions. 
Dr. Bryce would, I am sure, also do something; but at all 
events he would not restrain these patients. What would he 
do ? He could control all these patients by having strong, 
vigorous attendants constantly hold them, or be so near them 
as to be ever ready; he could also control them by giving J 
gr. morphia with 1-60 gr. of hyoscine (repeated, if neces- 
sary), or some other hypnotic or soporific. Ah! but I have 
almost forgotten—kind words! These do wonders. Yes, so 
they do, in many cases of insanity. But in the instances 
mentioned they would do about as much good in deterring 
these patients as they would in mitigating the force of a 
Dakota blizzard. Now I hold that a merciful restraining 
apparatus is far more humane than the use of strong drugs 
or strong attendants (although both these have their places). 
But if Drs. Bryce and Wise would manage the cases cited 
not only without any restraint, but also without the use of 
the other means I have suggested, I would very much like to 
know how they would do it. 
I have myself done patients injustice by being at one time 
too much imbued with the “absolute non-restraint” idea. 
Let me relate a single instance. I had under my care, while 
assistant physician at Danville, Pa., a lady who suffered 
from delusions of persecution. She was occasionally greatly 
agitated. In one of her disturbed periods she developed the 42 
MECHANICAL RESTRAINT IN THE 
most violent suicidal proclivities and desires to inflict bodily 
injury upon herself. I ordered two attendants to watch her 
closely, but not to harass her by taking hold of her unless 
absolutely necessary. In the evening I found the patient 
with a terrible bruise on her forehead, the result of bumping 
her head against the wall. An attendant was ordered to be 
with her constantly. That same evening the patient, in 
spite of this surveillance, tore three of her finger nails off, 
and said she was determined to “finish the job.” Next 
morning she was placed under the especial care of two 
attendants, who walked with her, and never left her for an 
instant. In spite of this she took a dive head-foremost on 
the floor, and broke her nose. I now laid aside my “ abso- 
lute non-restraint” notions, and put a muff on her, and per- 
mitting her to walk in the ward only arm-in-arm with an at- 
tendant; she was restrained in bed at night. This rigid 
system was kept up for four or five days. It was gradually 
removed as the unfortunate woman returned to her usual 
condition. I may say that this patient was a very cultivated, 
refined lady. When her usual medical condition had returned 
she said to me one day: “Sir, I fear that, owing to your 
contributory negligence, I shall have a deformed nose all my 
life. Did you not know that I was utterly incapable of re- 
sisting those terrible inward promptings to kill myself ? ” I 
felt the rebuke keenly. 
I hold that it is wrong in itself to take the stand “no 
restraint under any circumstances,” for the Superintendent 
who does take it may allow patients to mutilate themselves or 
suicide just to make a record in following his cast-iron rule. 
Kindness ! So much cant and sophistry has been uttered 
on this subject that one is almost nauseated to read some of 
it. Of course it is a wondrously potent quality in a medical 
office or attendant in an insane asylum, or in any one else; 
but to contend that it will invariably have power in quieting care and treatment of the insane. 
43 
patients, is farsical. Kindness would have no more effect 
on the violence of the epileptic than it would have on the in- 
furiated bull charging on his victim. Of course harshness is 
always wrong. 
Certainly there is danger that restraint maybe (as it has 
been), carried too far. Is there any good thing which may 
not be abused ? There is more danger to patients in asylums 
where absolute non-restraint is the rule than where re- 
straint is used in proper degree and amount. As a matter 
of fact but a small amount of restraint will be needed 
in a well-regulated asylum containing as many as a thousand 
patients. 
The cast-iron rule of “ absolute non-restraint ” is scarcely 
less pernicious than too much restraint. 
THEODORE DILLER. 
Pittsburgh, Sept. 28, 1891. 
Dr. P. Bryce, to whom I sent a copy of Dr. Diller’s paper, 
requesting his views, replied as follows: 
Alabama Insane Hospital, Tuscaloosa, Ala., Oct. 8, 1891. 
To the Editor of the Medico-Legal Journal: 
Dear Sir:—I have read Dr. Diller’s paper carefully over, 
as you request, and find nothing in it that has not been satis- 
factorily answered a hundred times within the last decade. 
The point the Doctor seems to be aiming at is that “judi- 
cious restraint” and not “absolute non-restraint” should be 
the guiding principle in the management of the insane. He 
does not deny that there are scores of hospitals, both at 
home and abroad, that are successfully conducted without 
the use of mechanical restraint of any kind. He does deny, 
however, that this system is either as humane or as success- 
ful in its general results as what he designates the “ system 
of judicious restraint.” Of course the mere affirmation of a 
loose and narrow generalization like this carries no weight 
with thoughtful, disinterested inquirers after truth. “ Judi- 44 
MECHANICAL RESTRAINT IN THE 
cions restraint” sounds very well on paper, but when and 
where was it ever put into practice ? In the use of power 
the best of men can rarely be trusted. But when it is borne 
in mind that the exercise of this power is distributed among 
hundreds of superintendents, asssistant physicians, super- 
visors, and nurses, it is really amazing that any thoughtful 
physician, who has had the least experience in the care of a 
large hospital for the insane, should be found to advocate it. 
I am speaking now in no disparaging manner of my con- 
freres. We are all alike. I know by experience that I can- 
not trust myself to act always “judiciously” in the exercise 
of absolute authority. Neither can I ascertain all the facts 
in every case, among my twelve hundred patients, calling for 
the exercise of this power; and I am therefore compelled, 
even were I “judicious” myself, to rely very largely upon 
the judgment of others. 
In a large hospital of a thousand or more patients, how 
can the medical superintendent or his busy assistants find 
time to investigate carefully every case that is reported by 
the supervisors or nurses as proper subjects for mechanical 
restraint? In the application, therefore, of what Dr. Diller 
designates “judicious restraint” we see that so much de- 
pends on the temper and discretion of subordinates, that 
abuses must almost necessarily creep in. 
But my own experience has taught me that mechanical re- 
straint, whether “judiciously” applied is in the end 
productive of more harm than good so far as the welfare of 
the patients as a whole is concerned. The mere fact that 
strait jackets, muffs, bed straps, crib bedsteads, and other 
such degrading apparatus are used in the hospital is quite 
sufficient to engender a spirit of insubordination, distrust, 
and discontent among the inmates. And its effect upon the 
nurses and others having immediate control of the patient is 
hardly less demoralizing and pernicious. It quickens the Portraits of Eminent Alienists and Medical Men. 
GERSHOM H. HILL, M. D., THEO. DILLER, M. D., 
Independence, Iowa. Pittsburgh, Pa. 
WM. P. SPRATLING, M. D., H. O. JEWETT, M. D., G. R. TROWBRIDGE, M. D., 
Morris Plains, N. J. Cortland, N. Y. Danville, Pa. 
W. H. HAVILAND, M. D., MIDDLETON MICHAEL, 
Butte, Montana. Charleston, S. C. 
J. T. STEEVES, M. D., S. V. CLEVINGER, M. D., F. T. FULLER, M. D., 
St. John, N. B. Chicago, 111. Raleigh, N. C. 
O. W. ARCHBaLD, R. J. DUNGLISON, M. D., 
Jamestown, Dakota. Philadelphia, Pa. CARE AND TREATMENT OF THE INSANE. 
45 
temper, and creates a spirit of impatience, often of arro- 
gance, which is extremely harmful. It begets, too, a spirit 
of intolerance which leads to threats, irritates and harasses 
the patient, instead of kind words, which soothe and placate 
him. 
That a case now and then presents itself in which mechan- 
ical restraint would be of service to the patient, I do not 
doubt, but the effect of such discipline upon the household 
at large would be anything but beneficial, and it would be 
far better that this exceptional patient should suffer for want 
of such restraint, than that the peace, happiness, and self-res- 
pect ofthe entire household should be destroyed by the use 
of it. 
But even these exceptional cases are of much rarer occur- 
rence than Dr. Differ would lead us to believe. In the 
course of eleven years of absolute non-restraint in a house- 
hold of twelve hundred patients, I cannot recall a single case 
that has suffered the least damage for want of restraint—in 
fact that has not been better off without it. The case of 
acute delirious mania referred to by Dr. Differ, and the lady 
who suffered from such intense nervous excitement, growing 
out of her delusions of persecution, would have been placed 
in seclusion in this hospital, and not permitted, as they were, 
to rush up and down the wards, butting their heads against 
the waffs, and pitching headforemost upon the floors. These 
delirious forms of insanity should be kept quiet, in bed, if 
possible, and in an apartment separate from the main wards, 
prepared especially for their safe keeping and treatment. 
Quieting remedies should be administered, and everything 
done to abate the intense nervous excitement. Under such 
treatment in this hospital these cases of acute delirious in- 
sanity are generally soon quieted, and in a few days are able 
to take their accustomed places in the wrork rooms or in the 
wards. It may be that an extra nurse is required for a while, 46 
MECHANICAL RESTRAINT IN THE 
to keep the patient in bed, and to give such attention as a 
very sick or delirious person needs; but this is a require- 
ment easily met, and withal comparatively inexpensive. 
There are a number of chronic dements in every hospital 
who occasionally strip themselves of their clothing, destroy 
furniture, break glass, etc., and these persons, more than any 
others, would seem to call for manual restraint; but our ex- 
perience goes to show that even they are better off in the 
end without it, and that a little closer watching and training 
on the part of their nurses does more to break up the bad 
habit than the severer measures of restraint. 
It is certainly true, in the history of this hospital, that 
there is less destruction of furniture and clothing, less break- 
age of glass, less violence to self and others, and less turbu- 
lence generally, under the system of absolute non-restraint 
than there was when we practiced what Dr. Differ caffs 
“judicious restraint.” Not only so, but the inmates of the 
hospital are happier, have more respect for themselves, are 
less discontented, more industrious, more confidential in 
their relations to the officers, nurses, and others, and more 
appreciative generally of the effort made to secure them all 
the comfort and liberty consistent with their mental condi- 
tion. There has been fewer suicides, fewer fights, fewer in- 
juries to self and others, since we abandoned restraint than 
there was before. 
Ninety per cent, of our women and seventy-five per cent, 
of our men are daily engaged in useful and profitable labor. 
The men have the free use of spades, shovels, axes and other 
farming implements, while at least fifty of our better class of 
patients work in shops where a fuff set of carpenters tools 
are of easy access and in constant use. Accidents rarely 
occur from abuse of these privileges—so rarely, indeed, that 
I cannot now recall a single instance within the past twelve 
months. I believe this state of affairs is largely due to the CARE AND TREATMENT OF THE INSANE. 
47 
abolition of all mechanical restraint and other harsh measures 
in the treatment of the patients. 
In conclusion, we find nothing in Dr. Diller’s paper to in- 
duce us to change our views after an experience of eleven 
years in the non-restraint treatment of our patients. That 
the Doctor and others have tried the system and failed in 
securing satisfactory results is no evidence that the system 
itself is at fault or impracticable, and does not weigh one 
iota against the long, unbroken and successful experience of 
scores of hospitals for the insane, both in this country and in 
Europe. 
Instead, therefore, of heaping personal abuse upon the ad- 
vocates of non-restraint, and impugning their motives, as he 
does in the beginning of his paper, it might be more profit- 
able for the Doctor to inquire a little more closely into their 
methods of management, and discover, if he can, the cause 
of his own failure, and the secret of their success. 
P. BBYCE, M. D., 
Sup't. 
I received the following reply from Dr. P. M. Wise, now 
Superintendent of the new St. Lawrence State Hospital, at 
Ogdensburg, New York, who was for many years Superin- 
tendent at the State Asylum for the Chronic Insane, at 
WTillard, N. Y., to whom I wrote as I had before written 
Doctor Bryce: 
St. Lawrence State Hospital, Ogdensburg, N. Y., Oct. 19, 1891. 
Clark Bell, Esq.: 
Dear Sir:—The nauseating effects of “non-restraint” 
literature upon Dr. Differ would indicate that he confined 
his reading to reports and discussions that were current a 
half dozen years since. He certainly has no reason to be 
“nauseated” by any non-restraint doctrine emanating from 
me, and unwarrantedly uses my name, as well as that of 
other esteemed medical men, in this connection. If he 48 
MECHANICAL RESTRAINT IN THE 
would take the trouble and read my reports for the last seven 
or eight years he would find my position in regard to res- 
training apparatus in the care of the insane definitely stated. 
Briefly stated, my belief is that any means, material, 
moral, or intellectual, that can be applied for the alleviation 
of insanity, is within the province of the physician to use. 
If it was my judgment that the application of a mechanical 
contrivance to an insane person would be the means of cure 
or improvement, there would be no hesitation in its applica- 
tion. I would not, however, follow the example of Dr. 
Diller, and tie an insane woman’s hands in a leather muff to 
prevent her from breaking her nose upon the floor. It re- 
quires some intelligence, by the way, to select cases that 
would be benefitted by restraint, and it is remarkable how 
seldom it is used when the inquiry is so directed. 
The restraint question is practically settled in this country, 
and Dr. Diller’s threshing .of old straw will not yield him 
anything. There is no difference of opinion at the present 
day among Superintendents who are abreast of the times; 
and, if the practice does slightly differ, it is a matter of very 
little importance, except in the estimation of some hysterical 
sentimentalists. 
As a matter of practice, I do not use restraining apparatus. 
My assistants do not find occasion for its use, and my attend- 
ants do not understand its use, but this would in nowise 
deter me from its use, if, in my judgment, it wonld be a 
saving element in treatment. 
I hope I am understood. 
I am respectfully yours, 
P. M. WISE. 
Believing that the views of those who had experience in 
hospitals for insane, and others who had studied the subject, 
might be of service in arriving at an intelligent consideration 
of the question, and without regard to the views entertained CARE AND TREATMENT OF THE INSANE. 
49 
by any upon the subject, pro or con, I enclosed a copy of 
Dr. Diller’s paper to several Superintendents and others 
whom I regarded as competent to speak, and wrote letters 
substantially as follows, after deciding to bring Dr. Diller’s 
paper before the Medico-Legal Society, at the November 
meeting, for discussion: 
My Dear Sir:— 
I enclose copy of a paper by Dr. Theo. Diller, of Pitts- 
burgh, Pa., that will be read at our meeting, November 11th, 
inst. Dr. P. Bryce and Dr. Wise will, I hope, reply, and 
some others. I would be glad to have your views upon the 
question. 
Should not the fact that such Superintendents as Dr. 
William Orange and others in England, Dr. Bryce, Dr. Wise, 
Dr. Alice Bennett, Dr. Alder Brumer, Dr. W. B. Fletcher, 
Dr. J. C. Shaw, and many others here, who have been for 
years able to carry on their work without resorting to mechan- 
ical restraint, be quite conclusive that it was not indispensa- 
bly necessary ? 
And should not all those who have the insane in charge 
feel a common interest in reducing this system of restraint 
to its minimum, and in correcting acknowledged abuses. 
Kindly let me have your views as early as possible. 
Faithfully yours, 
CLARK BELL. 
I had previously sent a copy of the paper of Dr. Diller to 
Dr. Henry Maudsley and Dr. William Orange, of London, 
and to eminent men in Scotland, Ireland, Belgium, and 
France for their views upon the general questions involved 
in the discussion opened in the March number, 1891, of the 
Journal, and had also written Dr. D. Hack Tuke, advising 
him that Dr. Diller’s paper would be read, saying his views, 
if stated, would be published, and asking him to advise Dr. 50 
MECHANICAL RESTRAINT IN THE 
Savage of the fact, and furnish him with the copy of Dr. 
Diller’s paper I had enclosed. 
Many replies were received, quite a number of which were 
read at the session of November 11, 1891, and the authority 
of the Society given to publish the same in the Journal. 
Dr. William B. Fletcher, who for many years was 
Superintendent of the Indiana State Asylum at Indianapolis, 
replied as follows: 
Indianapolis, Ind., November 2, 1891. 
Hon. Clark Bell, Pres. Medico-Legal Society, N. Y. 
Dear Sir:—By mechanical restraint in the treatment of 
the insane I understand that which hampers, holds, or com- 
presses any limb or member of the body. 
In a sane person—a criminal, for instance, with gyves 
upon his wrists and legs, or bound by cords, no reflex forces 
are excited. Reason shows the strength of the fetters, 
judgment tells they cannot be broken; hence neither galls, 
bruises, nor exhaustion of strength is produced by a fruitless 
contest of forces. The sense of physical restraint to a 
person with acute delusional mania—or epileptic mania— 
is to throw the whole nervous and vascular system into a 
state of resistance which only ends by complete exhaustion 
or death. 
In eight years’ constant association with the insane, in a 
hospital with sixteen hundred patients half that time, and in 
private practice with only acute insanity the other half, I 
have seen no case where I believed mechanical restraint 
necessary for the safety of the patient or advisable for treat- 
ment. 
I am a believer in therapeutic restraint, in that it stops 
excitement, it prevents reflexes, it produces rest, and rest 
promotes recovery. With the advance in our knowledge of 
therapeutic agents there is no need of a person dying from 
exhaustion or of injuring himself or others. Words of kind- CARE AND TREATMENT OF THE INSANE. 
51 
ness, firmly spoken, are of decided benefit to persons with 
acute mania, for they are always remembered. Physical 
force and words of command are only adapted to the treat- 
ment of a quiet class of indolent, neurasthenic, hysterical 
cases, who, like army mules, require a fire to be built under 
them to make them pull out. 
Yours very truly, 
W. B. FLETCHER. 
Dr. Charles W. Pilgrim was trained at the State Asylum 
for insane criminals, at Auburn, under the superintendency 
of Dr. C. F. MacDonald, and at the Utica Asylum, he 
had served under Dr. Blumer after the death of Dr. 
Gray, and when Dr. Wise took charge of the new State 
Asylum at Ogdensburg, N. Y., Dr. Pilgrim took charge of 
the Insane Asylum at Willard, which had been for so many 
years under Dr. Wise, and before him of Dr. Chapin. I 
submit Dr. Pilgrim’s reply: 
Willard State Hospital, Willard, Nov. 3, 1891. 
Clark Bell, Esq , 57 Broadway, New York: 
Dear Sir:—In reply to your letter of the 31st ult., I would 
say that I am a firm believer in the non-restraint system, 
although I should not hesitate to use mechanical restraint if, 
in my judgment, the patient would be benefited by it. It is 
my belief, however, that the use of mechanical restraint is 
almost never necessary. At least such is my experience 
with a population of nearly twenty-one hundred cases, many 
of which are acute. I have had several years’ experience with 
both systems, and I have no hesitation in saying that in my 
judgment an institution can be much more successfully man- 
aged without mechanical restraint than it can be with it. I 
am, Very truly yours, 
CHAS. W. PILGRIM. 
Dr. G. Alder Blumer, Superintendent at Utica State 
Hospital and successor to the late Dr. Gray, was at first 52 
MECHANICAL RESTRAINT IN THE 
disinclined to reply, but finally, on being urged, sent the 
following: 
Utica State Hospital, Utica, Nov. 5, 1891. 
Clark Bell, Esq., Medico-Legal Journal, 57 Broadway, 
New York City: 
Dear Sir:—It is emphatically an anachronism to be 
arguing the question of mechanical restraint in this year of 
grace 1891. The question is surely settled in this State 
among progressive alienists, and may be said to have finally 
resolved itself into this simple proposition: Mechanical res- 
traint is rarely justifiable. Five words are sufficient, and any 
amplification of the proposition is mere tedious verbiage. 
Non-restraint is nowhere accepted as a dogma, but it is re- 
cognized as a cardinal principle of treatment in all well- 
regulated hospitals for the insane. 
It is no “great honor and credit” to myself, as you are 
gracious enough to state, that it has not been found neces- 
sary to resort to mechanical restraint for several years at 
this hospital. I believe Dr. Carlos F. MacDonald (then of 
the State Asylum for Insane Criminals, at Auburn, N. Y.), 
was the first Superintendent to demonstrate the entire prac- 
ticability of non-restraint in this State. All we can justly 
claim is our openness to conviction, our willingness to follow 
the lead of others in anything that makes for the betterment 
of hospitals for the insane, and our contempt for puerile 
stickling as to questions of priority in any humane move- 
ment. 
On February *27th, forty-six years ago, Dr. Amariah 
Brigham, the first Superintendent of this asylum, wrote to 
Dr. Pliny Earle, a letter in which I find the following para- 
graph : 
“ I have determined to try the disuse of mechanical res- 
traint, a la Conolly. I have hired additional help, and got 
all hands ready to co-operate, and will earnestly and fairly CARE AND TREATMENT OF THE INSANE. 
53 
try it. I am inclined to think that, although such restraints 
do good in some cases (just as affew strokes of the whip would 
in some instances), yet the bad moral effect might counter- 
balance all good ; so I will try.” 
Would that some of our special pleaders for obsolescent 
methods of treatment would make the same faithful and con- 
scientious effort, instead of wasting their time in threshing 
the old straw of prejudice and conservatism, or at least in- 
dulge their solecisms in practical psychiatry with as much 
privacy as possible! 
Yours very truly, 
G. ALDER BLUMER. 
Dr. John B. CHAriN is an alienist of experience, who for 
years was at the head of the Hospital for the Chronic In- 
sane, at Willard, N. Y., and was called to the charge of the 
Pennsylvania Hospital for the Insane, at Philadelphia, on 
the death of the lamented Dr. Kirkbride. 
His reply was as follows: 
Pennsylvania Hospital for the Insane, 
Philadelphia, Nov. 6, 1891. 
Mr. Clark Bell: 
My Dear Sir:—Your note, accompanying the article by 
Dr. Diller, was duly received. I reply briefly that during 
the past twelve years there has been a gradual reduction of 
the use of mechanical restraint in the care of the insane in 
the asylums and hospitals of this country. In several of 
these institutions it has been fairly and actually abolished, 
and in others rarely used. 
Whether we should adhere to a non-restraint plan of 
management as a dogma, or, as physicians direct its intelli- 
gent and proper use in certain cases without a liability to its 
abuse, are important questions. That restraint may in cer- 
tain cases be applied with good results to accomplish strictly 
medical purposes, I am willing to concede. 54 
mechanical restraint in the 
The abolition of unnecessary mechanical restraints has 
come about, and has been possible, only by training attend- 
ants to perform a better quality of service. Non-restraint is 
but one of the incidents, and one of the accompaniments of 
an improvement in the system and methods of caring for the 
insane Avhich has been going on for several years, but can- 
not be called a “system.” 
Truly yours, 
JOHN B. CHAPIN. 
Dr. D. Hack Tuke, the descendant of the Elder Tuke, who 
was a contemporary of Pinel, one of the founders of York 
Retreat, is one of the editors of the Journal of Mental 
Science, and whom Dr. Diller had quoted as an Asylum 
Superintendent. He responded to my note briefly as 
follows: 
Hanwell, W. England, 
October 21, 1891. 
Thanks for letter and the enclosure. I am afraid I am 
too late to ask you to alter the wording of the passage in 
which Dr. Diller speaks of Dr. Savage and myself as super- 
intendents. If not too late, let me be referred to not as a 
superintendent. If anything let it be as one who in private 
practice approves of and occasionally employs restraint. It 
is a pity the writer made the mistake. 
Sincerely yours, 
D. HACK TUKE. 
Clark Bell, Esq., Barrister, President of Medico-Legal So- 
ciety, New York, U. S. A. 
Henry Maudsley, M. D., London. No medical man in 
London, if in the world, has greater renown among English 
speaking writers and thinkers in the domain of mental 
research than Dr. Maudsley. His most celebrated work 
on “The Mind” gave him international fame. Intimately 
related to Conolly, and a close observer and factor in CARE AND TREATMENT OF THE INSANE. 
55 
those changes that brought the reformers’ views into uni- 
versal acceptance in England, he has had an experience and 
knowledge of the subject second to no Englishman now 
living. 
His reply, which, with Dr. Hack Tuke’s, was received in 
time for the November meeting of the Society, was as 
follows: 
12 Queen Street, Mayeair, W. London, 
29 October, 1891. 
Dear Mr. Clark Bell : 
I am sorry, not surprised, to learn what Drs. Hack Tuke and Savage 
have done to comfort and aid those who use mechanical restraint to treat 
disordered minds. 
It could hardly fail to be so, for the mischief of the thing is that it ap- 
peals forcibly to those who by natural temper and lack of sympathetic 
imagination are prone to use it, and, using it, pretty sure to slide into the 
abuse of it. Were there no argument against its use but the certainty of 
its abuse, that might well be enough to forbid it; seeing that those who 
could use it wisely find that they don’t need it, while those only need it 
who ought not to be trusted with it. 
It does not really prevent struggling with and violence to patients, as 
contended, but, on the whole, by brutalizing attendants, probably tends to 
increase it. The enclosed newspapaper extract with regard to an inquest 
at Bethlehem—by no means a solitary instance—will show you what I 
mean. 
It is a pity that Drs. H. Tuke and Savage never had any practical train- 
ing in a large asylum where no use was made of mechanical restraint. 
They speak, therefore, however self-confidently, without really adequate 
knowledge. The former, so far as I know, has had no practical experi- 
ence whatever in the management of an asylum—never even lived in one— 
and the latter had no special training when he went to Bethlehem, where 
restraint grew to such a height, before his resignation, as to move Dr. 
Bucknill (one of the governors), to protest publicly. Two years before 
that I had written an earnest protest privately to Dr. Savage. 
I hope, therefore, your countrymen will not overrate the authority of 
those gentlemen, especially when lit is remembered that our country 
asylums—the best training ground for asylum management—have been 
conducted well for 30 or 40 years, by men nowise inferior to them in any 
respect, and superior in practical experience, without mechanical restraint. 
Moreover, Morel, who came to England specially to study the system of 
non-restraint at Hanwell, adopted it, and Greisinger also was its advocate. 
For my part, I can’t help saying that I had rather go wrong with 
Morel and Greiesinger than go right with Drs. Savage and Hack Tuke. 
Believe me, yours faithfully, 
H. MAUDSLEY. 
P. S. I am sorry I can’t undertake to send you a paper. The argu- 56 
MECHANICAL RESTRAINT IN THE 
merits pro and con have been repeated ad nauseam. And the tone and 
style of the proof which you kindly enclosed amply prove how useless 
any argument addressed to the mind of its writer would be—unless it was 
an argument that jumped with his conclusion. 
The extract enclosed was from the London Standard of 
December 23, 1887, and was an account of an inquest held 
by Coroner S. F. Laugliam at Bethlem Hospital on Wm. S. 
Smith, an inmate who had died there the preceding Sunday. 
The post mortem made by order of the coroner disclosed 
that the 5th rib on the right side was broken completely 
through, and the 5th and 6th rib on the left side partially 
broken through. The assistant medical officer was not 
aware of any injury to the ribs until the post mortem was 
made. There was no evidence to show how the ribs were 
broken, though the head attendant and the attendant in 
charge were both sworn, but disclosed nothing on that 
subject. The wife of the deceased stated that her husband 
had been forced into a canvass suit, and claimed that her 
husband had died from violence at the hand of an attendant 
named Wilson. The coroner said to her, “ But you have 
heard what the attendants say.” She replied, “Yes, but of 
course they would not incriminate themselves. They told 
me they had to use violence to put him into the dress.” 
The verdict under the coroner’s charge was “Death from 
blood poisoning resulting from fractured ribs, but how oc- 
casioned there was no evidence to show.” 
It was shown he had received a blow on the nose from an 
inmate, but aside from the statement of the wife, there was 
no evidence as to how the ribs were fractured. 
Dr. L. A. Tourtellot, for sometime connected with the 
Utica Asylum, New York, replies as follows: 
To the Editor of the Medico-Legal Journal: 
Sir:—It is true that the doctrine of non-restraint in the care of the in- 
sane is not based upon any theory of the nature of insanity, or its scien- 
tific treatment. While denying the use of mechanical restraints, we must 
admit that restraint, both moral and physical, is part of a proper system HON. DANIEL M. VALENTINE, 
Associate Justice Supreme Court, Kansas. CAKE AND TREATMENT OF THE INSANE. 
57 
of care and treatment. No one, indeed, can deny the necessity of a con- 
trol of the insane by their attendants, or the utility of locked doors and 
guarded windows in most parts of an asylum. 
But the doctrine is a practical one, and if the experience of a large 
majority of our profession, in this country and in Europe, is trustworthy, 
the insane can be treated to the best advantage, with reference to their 
comfort and safety, as well as their cure, by the system of non-restraint. 
In what does this advantage consist? 
The most serious abuses found in asylums are, of course, the injuries, so 
often fatal, inflicted upon patients by their attendants. In every investi- 
gation of these abuses which has come to my knowledge within the last 
thirty years, the lesson of the verdict or report has been the necessity of a 
more careful selection of attendants, and their better training and disci- 
pline. Reform in this direction has been begun, but it will be slow while 
attendants are chosen and retained through the influence of politicians, 
as is the case in many of our asylums to-day. There is, also, the irreme- 
diable evil of the enormous size of these asylums, which renders it wholly 
impossible for their one responsible head to see that just and proper treat- 
ment is given to every patient. It is easy for attendants to combine to- 
gether to indulge their brutal passions or their love of ease, and the various 
mechanical restraints which have been devised are well-fitted to serve 
their purpose. There is no one to dispute with the attendant that the 
facts in any case are as he represents them, and if restraints are admitted 
to be necessary for one patient, they can be made to appear so for twenty 
or fifty. Now, it is in the unnecessary, and therefore unjust, use of these 
restraints, and in the resistance provoked by such use, that the greater 
number of cases of violence to the insane have their origin. Where the 
use of restraining apparatus is wholly forbidden, and especially where it 
is known that everything of the kind has been banished from the asylum, 
the methods of attendants must of necessity be changed. There is no 
safety except in constant watchfulness, and where the patient is no longer 
absolutely helpless, as when restrained by a camisole or muff, the proper 
means of moral control are resorted to, and are found effective beyond all 
expectation. From being a master, the attendant becomes the guardian 
and friend of his patient, whose delusions of enemies surrounding him 
slowly fade away, and the sense of injustice, which excited a desperate 
resistance to his tyrants, is no longer felt. 
It is plain that the non-restraint system requires a larger number and a 
better class of attendants than are found in asylums conducted according 
to the old method. But there can be no difficulty in fulfilling these con- 
ditions, if the financial reform of asylums is carried out according to the 
plans of the State Commission in Lunacy. When their treasuries are 
once released from the grasp of politicians, it will be found that ample 
funds are provided by the public for the additional cost of the non-restraint 
system and other kindred reforms. Among these is the abolition of 
chemical restraints, in the shape of stupefying and depressing drugs. 
There is a strong tendency in asylums which are driven to the policy of 
non-restraint by the pressure of public and professional opinion, to substi- 
tute chemical restraints tor mechanical ones. Their use is, in my opin- 58 
MECHANICAL RESTRAINT IN THE 
ion, equally dangerous to the lives of patients, and they do more to des- 
troy the hope of cure in curable cases than all other abuses in the adminis- 
tration of our asylums. 
In holding the doctrineiof non-restraint in the care of the insane, let me 
say again that we should not give it the force of a moral law or a scientific 
induction. I believe that in ninety-nine cases out of a hundred in which 
restraints were formerly thought necessary, their disuse is not only practi- 
cable, but in every way beneficial to the patient. But if in the hundredth 
case these means are clearly indicated, as offering the best hope of safety 
and recovery to the patient, no conscientious physician will hesitate for a 
moment to adopt them. The fact, however, that medical men of the 
largest experience and the highest character do not report such excep- 
tional cases, is proof that they are so rare as to furnish no argument 
against a system which has done more than anything else in the last fifty 
years to raise the standard of provision for the insane throughout the 
civilized world. 
L. A. TOURTELLOT, M. D. 
Utica, Nov. 7, 1891. 
Dr. James Olmstead, who for some years has been in 
charge of the Insane Hospital at Middletown, Connecticut, 
replies as follows: 
Connecticut Hospital for the Insane, 
Middletown, Nov. 3, 1891. 
Clark Bell, Esq.: 
My Dear Sir:—In reply to your favor received yesterday, it is most 
certain that all who have the insane in charge should feel a common in- 
terest in restricting their patients as little as possible. In this hospital 
the opinion has prevailed that mechanical restraint, like opium or alcohol, 
should never be used except by prescription of physicians, and in every 
instance the physician must be prepared to demonstrate that the restraint 
contributes to the benefit of the patient restrained. The use of mechan- 
ical restraint is thus reduced to a minimum, and it is believed that, pro- 
vided mechanical restraint is not left to the option of ward attendants, but 
is strictly under the direction of intelligent members of the medical pro- 
fession, abuses are not likely to occur. 
Very truly yours, 
JAMES OLMSTEAD. 
Dr. Carlos F. MacDonald, who was for many years Super- 
intendent of the New York Asylum for the Insane called 
Criminals, at Auburn, New York, has been recently been 
called to the Presidency of the State Lunacy Commission 
of the State of New York. 
He has a large and valuable experience, and is now exer- 
cising in his official capacity, in conjunction with the Board CARE AND TREATMENT OF THE INSANE. 
59 
of Lunacy Commissioners, a general supervision over all the 
asylums of the State. His reply was as follows : 
334 Fifth Avenue, New York City, Nov. 9, 1891. 
Mr. Clark Bell : 
Dear Sir:—Replying to yours of Oct. 31st, in relation to the subject of 
“Mechanical Restraint of the Insane,” I would say: I would consider it a 
waste of time to discuss that subject, at least so far as the State of New 
York is concerned, in the hospitals of which the practice of using mechan- 
ical restraint has been substantially abandoned, by common consent. 
Respectfully yours, 
carlos f. Macdonald. 
From communications made to me from various parts of 
this continent, and from some institutions in the State, it has 
seemed quite certain that Dr. Carlos F. MacDonald and many 
of our ablest alienists in this State were not at all aware of 
the extent and spread of the use of mechanical restraint in 
American asylums at the present moment, and that it was 
coming again into vogue under the authority of such names 
as Dr. Hack Tuke and George H. Savage and others, who 
gave countenance to its continuance. 
The editorial article in the March number of this journal 
was inspired by such a conviction, and this discussion was 
initiated for the two-fold purpose of— 
1. Illustrating to the profession and the public that the 
abuses still exist in certain quarters, and— 
2. To show those who have not yet tried to dispense with 
such restraints, the propriety and feasibility of making the 
trial, as well as to encourage all such by the example of 
those who have succeeded in eliminating it wholly from hos- 
pital practice. What Dr. Maudsley, Dr. Orange, Dr. 
Nicholson, and all the English Superintendents have done so 
long at Hanley, Broadmoor, and throughout Great Britain— 
what Dr. Bryce, Dr. Wise, Dr. Blumer, Dr. Pilgrim, Dr. 
Shaw, Dr. Alice Bennett, Dr. Fletcher, and so many 
others have done—can be done by others if the trial is sin- 
cerely and earnestly made. 60 
MECHANICAL RESTRAINT IN THE 
The succeeding replies, as well as Dr. Diller’s paper, will 
demonstrate the wisdom of the present discussion, and aid 
us, under Providence, with an early solution of the question. 
Dr. Gershom H. Hill, with a large experience in the Iowa 
State Hospital for the Insane, writes as follows: 
Iowa Hospital eor the Insane, Independence, Nov. 5, 1891. 
Clark BELL, 57 Broadway, N. Y.: 
My Dear Sir:—Your letter, and a copy of the paper by Dr. Diller, have 
been received. There is not the least doubt in my mind about the ability 
of any Superintendent to get along under all circumstances and always 
without the use of mechanical restraint. The only question in my mind 
is with regard to the advantage of declaring that restraint shall not be 
used in a given institution or in any institution for the insane under any 
circumstances. In the first place every officer in an institution where the 
insane are cared for knows that he can do without restraint if he is sup- 
plied with all the attendants he needs. The next question is -whether 
there are not cases in which it is preferable to use a mild form of restraint— 
for example, a covered bed—instead of having the patient kept in bed 
by close watching or by being held by an attendant, one or more. In 
this hospital we never use camisoles nor bed-straps, but once in a great 
while we may put leather mittens on a patient to prevent her from tear- 
ing up her clothing or indulging in filthy habits. We use covered beds 
to a limited extent for acute cases, who are suffering from nervous ex- 
haustion. I still believe that there are a few patients admitted to the 
hospital from time to time who will be more composed and thrive better 
in a form of restraint which is not uncomfortable than they would by 
being held or closely yvatched by attendants. Sometimes a patient re- 
quires a surgical operation or needs to wear bandages for a few days, but 
will not leave the dressings alone without some form of restraint. 
In thisi hospital we have all the money we need to pay running ex- 
penses, and I am at liberty to hire all the help necessary to properly care 
for the patients. We are not particularly crowded, so that we can do 
all we wish in the management of our patients. We have in the house 
to-day 834 patients. We have on an average one attendant for every ten 
female patients, and one attendant for every fourteen male patients. If a 
covered bed is reckoned as a form of restraint, then we restrain on an 
average about one-half of one per cent. Concerning other forms of 
mechanical restraint, I do not think the average here would exceed one- 
sixteenth of one per cent., and yet I am not in a frame of mind to declare 
that we will never again use any form of mechanical restraint except the 
covered bed, and I am fully persuaded that the form of covered bed which 
we use, and which was devised by myself, is a great blessing to a few ex- 
hausted patients. This covered bed has a woven wire bottom, is always 
provided with a curled hair mattress, it has spindles at the sides and ends, 
and a frame of wire netting for a cover. This cover is fastened to the 
sides with straps, and can be separated from the bedstead, if we wish to use HON. WILLIAM A. JOHNSTON, 
Associate Justice Supreme Court, Kansas. CARE AND TREATMENT OF THE INSANE. 
61 
the bed as a crib without a cover when a patient begins to regain self-con- 
trol, and has become accustomed to the bed so that he will lie there quietly 
without the use of a cover. 
I have frankly and fully stated the custom of this institution, and my 
opinions concerning mechanical restraint. 
I shall be glad to learn which side of the question secures the prepon- 
derence of opinion. I am, 
Very respectfully yours, 
Dictated. GERSHOM H. HILL- 
P. S. Patients in restraint are carefully watched here, but a single 
patient seldom has the whole time of one or more attendants. 
Dr. Selden H. Talcott, at the head of the State Homeo- 
pathic Hospital, at Middletown, in the State of New York, 
a man of long and valuable experience there, replies as 
follows: 
Middletown State Homeopathic Hospital, 
Middletown, N. Y., Nov. 7, 1891. 
Clark BELL, Esq., 57 Broadway, New York City, N. Y.: 
My Dear Sir:—Yours of October 31st is at hand. My views upon the 
restraint question were expressed in the twentieth annual report of this 
institution. I send you a copy of our last report by this mail, and refer 
you to pages 79, 80, and 81. 
While some good men are opposed to mechanical restraint under any 
circumstances, other men, who may be equally good, are in favor of res- 
training insane patients under certain circumstances. During the past 
summer I have conversed with some of the best alienists of Europe upon 
the subject of restraint, and while they expressed themselves as de- 
sirous of dispensing with its use as far as possible, they still believe that 
the use of restraint should be permitted in some cases. I believe, with 
Sir Arthur Mitchell, of the Lunacy Board of Scotland, that we should 
prohibit no means which might prove beneficial, but stand ready at all 
times to use everything in behalf of the insane that would be likely to 
benefit them. 
Very truly yours, 
SELDEN H. TALCOTT. 
Dr. W. W. Godding is one of the foremost American 
alienists. He is Vice-President of the Medico-Legal Society 
of New York, for Washington, D. C., at the head of the 
Government Hospital for the Insane, and has been Presi- 
dent of the National Association of American Superintend- 
ents of Insane Asylnms. 
His reply is as follows: 62 
MECHANICAL RESTRAINT IN THE 
Government Hospital for the Insane, 
Washington, D. C., Nov. 8, 1891. 
My Dear Sir:—There is a great deal of nonsense in all this talk about 
the use of mechanical restraint in the treatment of insanity. I have else- 
where said what I have to offer on this topic, and will detain you with but 
a single sentence here. It is what good old Dr. Butler, of Hartford, 
Conn., after sixty years of conscientious labor among the insane, wrote 
down as the summing up of his life knowledge on the subject, viz: “The 
Individualized Treatment of the Insane.” That is what we want—the 
care of the individual, in this as in any other sickness, as his need may 
appear—not the treatment of insanity in the concrete by any formula. 
We may say in a general way that more cases of insanity are cured by 
judiciously supervized exercise in the open air than by confinement in 
bed by a Wyman bed-strap. This does not prove that in the individual 
case in question such confinement may not be necessary to save life, and 
the ‘ ‘ enlightened public opinion ’ ’ that would forbid its use under the 
direction of the physician having the case in charge—as much responsible 
for the recovery as if it were the delirium of typhoid fever—would savor 
of an enlightenment that even in Darkest Africa would pass for shadow. 
You do not dictate to the physician skilled in medicine or surgery what 
remedial agents he shall employ in any other form of disease, and you 
cannot afford to do it in the case of the insane man. Fortunately the 
leading mental alienists, as I have known them, are not timid men, and 
are not likely to be deterred from the use of mechanical restraint, in cases 
where they deem it necessary, by any considerations of policy, as Dr. 
Diller’s paper would seem to imply. If they resort to restraint or refrain 
from its use, it is from conviction that they are right. In this, as in all 
other critical situations, there is need for the medical man that he have an 
enlightened judgment and the courage of his convictions. 
Very sincerely yours, 
W. W. GODDING. 
Clark Bell, Esq., Prest. Medico-Legal Society, No. 57 Broadway, New 
York. 
Dr. John Curwen has been for years the Secretary of the 
Association of Medical Superintendents of American Insti- 
tutions for the insane, and at the head of the State Hospital 
for the Insane, at Warren, Pa. 
This is his reply: 
State Hospital for the Insane, 
Warren, Pa., Nov. 7, 1891. 
Mr. Clark Bell: 
Dear Sir:—I believe that restraint of a mild kind (connected sleeves), 
is absolutely necessary in certain cases to prevent the patient doing injury 
to others or to themselves, and to prevent the disposition, so common, to 
enude themselves, particularly among women. It is in every way better CARE AND TREATMENT OF THE INSANE. 
63 
for the patient than to be held by the hands of attendants, which very 
often provokes a struggle and injury sometimes to the patient. 
Chemical restraint is injurious in many ways. 
Restraint, when carefully and properly used, is simply a means of pro- 
tection. Very respectfully yours, 
JOHN CURWEN. 
I append the letter of Dr. H. P. Stearns, an American 
alienist of distinction, who, for many years, has been at the 
head of the Hartford Retreat for the Insane. Dr. Stearns 
has served as President of the American Association of 
Superintendents of Insane Asylums: 
Retreat for the Insane, Hartford, Conn., Nov. 14, 1891. 
Ceark Beee, Esq: 
My Dear Sir:—Your letter, with the enclosed paper by Dr. Diller, was 
duly received. I have on several occasions expressed my views about 
“non-restraint,” so called, and I have nothing new to say about it now. 
It is a thread-bare subject, and has been so for years. I suppose physicians 
will differ about the advisability of its universal practice, as they do on 
other points of treatment. A few Superintendents in this county will 
doubtless continue to use mechanical restraint, but I think the great 
majority use it only in very exceptional cases. 
I am very truly yours, 
H. P. STEARNS. 
Dr. Dewey is an alienist of eminence, who is at the head 
of the Illinois State Hospital for the Insane, at Kankakee, 
in. 
His reply was as follows: 
Illinois Eastern Hospital for the Insane, 
Kankakee, Nov. 20, 1791. 
Mr. Clark Bell, 57 Broadway, New York: 
My Dear Sir:—I regret that it has not been possible to reply earlier to 
your inquiry as to my views concerning mechanical restraint. 
In regard to this matter would say that I have not formed any theories, 
but have continually sought to pursue the course in reference to each 
patient which seemed to be the best for the individual. The important 
thing it seems to me, is to keep intelligence and kindness in control. 
With this view, it has always been the practice in the institution of which 
I have charge to have no restraining apparatus which could be controlled 
by anybody but the physician, the apparatus being accessible only to the 
physician. Whenever it has been called for or thought necessary the 
rule has been that the physician in charge should visit the wards and per- 
sonally investigate all the circumstances before any device for mechanical 64 
MECHANICAL RESTRAINT IN THE 
restraint could be used. The result of following this course has been that 
restraint has rarely been called for, and still more rarely used. In refer- 
ring to the records of the institution in the last six months in regard to 
this matter I find that in the female wards, with an average of 640 patients, 
outside of surgical restraint, which was employed for one patient who 
had a fracture of the humerus and three other patients having lesser surgi- 
cal injuries, there have been no instances of mechanical restraint, except 
the application of mittens for destructiveness, for brief periods, in sixteen 
cases. The mittens are perhaps mechanical restraint of the fingers, and I 
report them as mechanical restraint, although the limbs and the move- 
ments are not restricted in any way by this device. There was also one 
case in which manual restraint was employed for six hours in a case of 
excessive violence. 
In the male wards, with an average of over a thousand patients, there 
have been, from May to October, inclusive, four individuals to whom 
mechanical restraint was applied. One of these was a patient with an 
extensive eczematous eruption, which he persistently scratched, and in- 
creased the area of, whenever his hands were free. The diseased surface 
became so extensive and so deep that the assistant physician was author- 
ized to apply restraining apparatus to the hands. The restraint was con- 
tinued for a length of time, and the ulceration lessened considerably, 
but iny impatience with the use of the appliance was so great that I 
ordered it discontinued. This being done, the patient grew steadily worse, 
and inflicted such injuries with his nails that considerable hemorrhages 
resulted, and finding his condition growing steadily worse, I felt obliged to 
acknowledge that I had made a mistake, and returned to the restraint, 
which he is still wearing when he cannot be watched by the attendants, 
and the eruption is now nearly healed again. 
Of the other three individuals to whom mechanical restraint was applied, 
one was an extraordinarily persistent suicide, one was a patient whose vio- 
lence was utterly uncontrollable, and one wras a man with an altogether irre- 
sistible impulse to break glass whenever and wherever an opportunity 
offered. 
I regret that the time at my disposal is not sufficient to go further into this 
matter. 
Yours truly, 
RICHARD DEWEY, 
Medical Superintendent. 
Dr. C. H. Hughes is an alienist of international reputa- 
tion. He has had asylum experience, and founded and now 
edits the Alienist and Neurologist, at St. Louis, Mo. He is 
a corresponding member of the Medico-Legal Society, and 
Vice-President of the International Medico-Legal Congress 
to be held in 1893. His reponse was as follows: HON. MERCER BEASLEY, 
Chief Justice Supreme Court of New Jersey. CARE AND TREATMENT OF THE INSANE. 
65 
Marion-Sims College of Medicine, St. Louis, 
Chaik of Neurology and Psychiatry. 
My Dear Clark Bell: 
I should have answered your request for my views on the question of 
restraint, but for want of time and pressure of business. 
The subject, however, has been discussed so often and so thoroughly by 
the most eminent and experienced alienists of the world, pro and con, that 
it is now almost threadbare. 
Compared with the restraint system that prevailed before Pinel un- 
shackled the lunatics and took them out of the dungeon cells of Bicetre, 
and Tuke and Chiarugi inaugurated the reform of the present century in 
England and Italy respectively, non-restraint has become the rule and 
prevalent idea in the management of the insane ; that is, the abolition of 
all needless mechanical restraint, all restraints hitherto resorted to for other 
than purely medical or therapeutical reasons, such as the quiet of the 
asylum, the comfort or convenience of the officers, attendants, etc. And 
restraint is now never employed for purposes of punishment or coersion in 
any well-regulated medically-governed modern institution for the care or 
treatment of the insane. 
The question of restraint or non-restraint has been narrowed down to 
one of prescription for the psychical or physical welfare of the patient ex- 
clusively, and like any other prescription, the dosage of the remedy and 
the duration of its employment must depend on the absolute needs of the 
patient and judgment and skill of his physician, and like the tendency of 
the times in medical circles in regard to the use of medicine generally, the 
least amount of the remedy that will subserve the welfare of the patient 
meets with most favor among the most enlightened and advanced alienists. 
Non-restraint, as I understand it, is a relative, not an absolute term, and 
restraint, either mechanical or physical, when employed, should be of the 
least irritating kind to the patient, and least barbarous, coercive, or violent 
in appearance, and only as a medical prescription. 
Psychical tranquilization, psychical diversion or suppresion, are the ob- 
jects in view in the successful management of the insane, and psychical 
satisfaction to the patient, so far as this may be accomplised without encour- 
aging or fostering delusion or morbid impulse. The patient should be 
adroitly led, rather than forcibly coerced, in the direction of normal 
mental activity. An inherent dread of coercion and servitude exists in the 
minds of most persons, and this dread does not generally abandon the in- 
sane mind. Some lunatics are totally indifferent to the restraint which 
they need to guard them from filthy practice or dangerous impulses, as cer- 
tain epileptics, imbeciles, and dements, and some should have restraint, es- 
pecially at certain periods, as the homicidal, suicidal, etc., but not con- 
stantly, nor so much as has hitherto been thought a necessity of treatment. 
The general sentiment and practice of alienists is in the right direction, 
and I think the skilled judgment of the experienced psychiatrist may be 
trusted to indicate its proper use in those exceptional instances where it is 
imperatively required, and to decide upon the propriety or preference of 
mechanical, physical, or chemical restraint, or of seclusion solitary or of 
semi-solitary, or diverting exercise, such as a long walk, a physicially 66 
MECHANICAL RESTRAINT IN THE 
fatiguing game or exercise of any kind, or labor, watched oyer by surveilli- 
ance of experienced attendants. 
Thus, you see, in the light of my own experience, the testimony of 
others, and all of the past and recent exhaustive discussions of this subject, 
I regard the subject as a medical question of suitable prescription in special 
instances, and not as a rigid rule of practice, to be undeviatingly conformed 
to, and I prefer the non-restraint plan generally to restraint generally. I 
never would entrust the deciding of the question of restraint or non-res- 
traint to the judgment of any one but the physician. 
Yours truly, C. H. HUGHES. 
Dr. Lyon, of Bloomingdale Asylum, one of our oldest 
hospitals in the chy of New York, replied as follows: 
Bloomingdale Asylum, Boulevard and 117th Street, 
New Yoke, November 12, 1891. 
Clark Bell, Esq., President Medico-Legal Society, Buckingham Hotel, 
New York City. 
My Dear Sir:—This morning’s mail brings me your printed slip on Me- 
chanical Restraint, and your invitation to last evening’s discussion of the 
subject. 
I am fully convinced that mechanical restraint has as legitimate a place 
in the treatment of high excitement and exhausting mania as has any 
sedative medicine, properly administered, and I am satisfied that lives may 
occasionally be saved by husbanding the failing strength of intensely 
excited patients by mechanical appliances, which do not provoke the same 
combative resistance as manual restraint often does. The value of some 
form of mechanical restraint in the surgical cases which sometimes occur 
among very disturbed patients cannot be questioned. 
I also believe that the principal is generally recognized that mechanical 
restraint should not be used simply to save the time and labor of the 
attendants, who should be constantly with, and as carefully attentive to, the 
patient restrained as though he were free, nor in any case should its use 
with a patient become habitual, but it should always be a matter of daily 
and hourly prescription by the physician in charge. 
I may add that with between four hundred and fifty and five hundred 
patients a year under the care of this Institution, many of whom are in the 
most active stage of their disease, it is rarely found necessary to mechani- 
cally restrain anyone, but when the necessity arises, there is as little hesita- 
tion in using this remedial means as any other. 
Yours very truly, 
SAMUEL B. LYON, 
Medical Superintendent. 
Dr. Steeves, who is at the head of the Provincial Asylum, 
at St. Johns, New Brunswick, with a large experience, and 
a member of the Medico-Legal Society, in response to my 
inquiries, responded as follows: CARE AND TREATMENT OF THE INSANE. 
67 
Provincial Lunatic Asylum, St. John, New Brunswick, 
10th Nov., 1891. 
Dear Mr. Bell : 
I regret that by a misadventure your letter of the 81st ultimo was mis- 
laid, and not answered early as its import and the circumstances demanded. 
I read your remarks carefully and thoughtfully, and Dr. Theodore 
Diller’s paper on Mechanical Restraint of the Insane with the same care. I 
was about to say that I had tried absolute non-restraint, but I confess I 
have not, and I might add that the confession does not cost me much blush- 
ing ; nor do I suppose anyone has ever had the temerity to undertake so 
herculean and impossible a task as to manage exceptional cases of insanity 
by means that would admit of the term “ entire non-restraint.” 
You ask this apparently pertinent question : “ Should not the fact that 
such Superintendents,” as several more or less distinguished gentlemen 
whom you name, “who have for years been able to carry on their work 
without resorting to mechanical restraint, be quite conclusive that it was 
not indispensably necessary ? “ Not indispensably necessary.” I make bold 
to say that these words, in the connection in which they are used, are far 
from being ingenuous. When you are summoned to dinner, and take your 
seat by the well-furnished board, and perchance said a word of grace, you 
will see before you some things that are “ not indispensably necessary, ” but 
which add greatly to your comfort, your health, and your well-being. In- 
deed, examples of this sort could be furnished without number. But if you 
ask me if these gentlemen whom you name prefer manual and chemical 
restraint to mechanical restraint, is it not conclusive that mechanical res- 
traint should be abolished ? Then I would reply simply that it is not con- 
clusive by any manner of means. 
Your second question is child-like, and man-like as well. “And should 
not those who have the insane in charge feel a common interest in reducing 
this system of restraint to its minimum, and correct acknowledged abuses.” 
I go hand in hand with you in this crusade, and I will go further, for I will 
include with “this system of restraint”—meaning mechanical restraint, 
that of the non-restraint apostles, viz: that system of manual and chemical 
restraint practiced by them. I would say let us have no more rib breaking 
nor morphia stupor. 
Referring to Dr. Diller’s paper, I have to say that, excepting a few words, 
which I will presently name, I heartily endorse his views. And this 
endorsation is not from any superficial view, or partial study, or short ex- 
perience. For this question has been to me an everyday burning one for 
upwards of sixteen years, and to whatever conclusions other gentlemen 
may have arrived, even after having brought to bear on the subject much 
intelligence, time, and experience, my opinions are so firmly based that 
they are not likely to be moved thereby. 
If the arraying of distinguished names could be conclusive in settling the 
question of restraint or non-restraint, manual or mechanical, both sides 
would claim the victory. 
The exception referred to in Dr. Diller’s paper is this, that while I hold 
strong views against the prohibition of restraint in the care and manage- 
ment of the insane, qualify it by what adjective you will, and while I 68 
MECHANICAL RESTRAINT IN THE 
believe the proposition bears absurdity upon the face of it, I am unwilling 
to impute motives, or cast reflections on others who from some cause hold 
opinions opposed to mine. Even in the case of a bonfire one could afford 
to look on without perturbation. 
Faithfully yours, 
J. T. STEEVES. 
Dr. L. H. Prince, whom I had understood used restraint 
in his Hospital at Batavia, Illinois, responded as follows: 
Batavia, III., Nov. 2, 1891. 
Clakk Bell, Esq., President Medico-Legal Society, New York. 
My Dear Sir:—In reply to your circular letter of Oct. 31st, asking for 
an expression of my views on the subject of the use of mechanical restraint, 
I would respectfully offer the following : 
I am a firm believer in the efficacy of a judicious and proper use of chemi- 
cal, manual, and mechanical restraint in the treatment of insanity. Each 
has its special uses, and, in my judgment, no one of them can be entirely 
dispensed with properly in any hospital for the insane. There is no doubt 
that the use of mechanical restraint has been abused in many instances. Is 
this a sufficient reason for its abolition ? Then for the same reason should 
be abolished the use of chemical and manual restraint. Cases (especially 
of acute agitative melancholia) have come under my observation where it 
has been deemed necessary, principally on account of the exhausted con- 
dition of the patient, that rest in the recumbent position be maintained. 
Holding the patient in bed by attendants (manual restraint), in nearly every 
case resulted in increasing the excitement and consequent exhaustion. In 
most of these cases, after the failure of this form of restraint, the patients 
were kept on the bed in a horizontal position by the use of mechanical ap- 
pliances humanely applied, with the most satisfactory results. Can it be 
said by the advocates of non-restraint that none of their patients could pos- 
sibly have been benefitted, or at any time made more comfortable, by the 
judicious use of mechanical restraint ? Can it be positively asserted that 
no patient ever died for the want of it ? Very many cases might be cited 
where the occasional judicious use of mechanical restraint might be of 
benefit to the patient. If patients can, beyond all possibility of doubt, be 
benefitted by the use of the muffs, self-mutilators, for example, who re- 
sent being held by others, must they be deprived of this means of treat- 
ment because of a principle iuvolved ? And what, pray, must w'e do with 
a patient who asks for this means of restraint ? 
Will the advocates of non-mechanical restraint tell us how they manage 
such cases as require some form of restraint, and all Superintendant’s meet 
with these occasionally, where chemical restraint is insufficient or danger- 
ous, and where manual restraint is harmful, by adding to the patient’s ex- 
citement ? Howr do they prevent injury to the violent patient who is held 
for hours by several strong attendants ? Can they vouch for the gentleness 
of such attendants in all cases ? Do they not meet with patients who re- 
sent being watched and followed, and finally overcome and pinned down 
by superiorJforce ? CARE AND TREATMENT OF THE INSANE. 
69 
A layman visiting the asylum wards is shocked at seeing a patient res- 
trained by mitts or camisole. We are sorry for him, but as it is our duty 
to do our best for the patients, we cannot conscientiously deprive him of 
this means of treatment for the visitor’s sake. 
It is worthy of note that very many of the non-restraint advocates are 
non-medical men, and have never had experience in the treatment or 
management of the insane. If a physician cannot be trusted with appli- 
ances for mechanical restraint, how can he be trusted with the application 
of chemical or manual restraint ? I am heartily in favor of minimizing all 
forms of restraint, and of perfecting the methods we have, trusting to the 
humanity and ability of the physician to judge of the necessities of each 
case. I am decidedly opposed to any rule or law that takes out of the hands 
of the physician that which may be of benefit to his patients. Absolute 
non-restraint in the hospital care of the insane does not exist. The report 
that “no restraint whatever has been used” is misleading and unscientific. 
If there is a sure way of treating our patients, with advantage to them, 
without the occasional use of mechanical appliances, we should be happy to 
learn of it. The majority of hospital physicians, having the interests and 
comfort of their patients at heart, have not yet learned to dispense entirely 
with its use. 
The proper use of restraint of all kinds is what we should aim at, not its 
total abolition. 
Faithfully yours, 
L. H. PRINCE. 
Being anxious to liave the views of Dr. Prince upon what 
seemed to me to be the more important and practical ques- 
tions involved in the controversy, I addressed him the follow- 
ing letter: 
No. 57 Broadway, New York, Nov. 7, 1891. 
Dr. L H. Prince, Resident Physician Bellvue Place, Batavia, 111. 
My Dear Sir:—Many thanks for yours of the 2d instant just received. 
I am greatly interested in your views. Your criticism as to the views of 
laymen, was preconceived by me and influenced my action in calling now 
so largely not only upon medical men, but upon those who had experience 
in the care of the insane in hospitals. The Earl of Shaftesbury, for half 
a century the Chairman of the English Lunacy Board, was a layman, and 
yet, perhaps, no man, not even Conolly, was so largely influential in abolish- 
ing the chains, manacles, and other forms of mechanical restraint in British 
asylums than was he, and I believe that no prominent alienist in Great 
Britain could now be found, who would regard his experience and judg- 
ment as at all inferior to any asylum physician upon this question. 
I should be glad to have you give me your views as to the following 
propositions: 
1. If such men as Dr. Wm. Orange, as superintendent of Broadmoor, the 
great asylum for the insane called criminals in England; Dr. P. Bryoe, at 
the head of the State Hospital at Tuscaloosa, Alabama; Dr. Alice Ben- 
net, Superintendent of the largest State Hospital for women in the world, at 70 
MECHANICAL RESTRAINT IN THE 
Norristown, Pa.; Dr. P. M. Wise, now at the head of the State Hospital for 
insane at Ogdensburgh, N. Y., for many at the largest hospital for the 
chronic insane, at Willard, N. Y.; his successor, Dr. Chas. W. Pilgrim, at 
the same institution; Dr. Wm. B. Fletcher, of the greatest asylum in 
Indiana, should unite in saying that they had not found it necessary during 
the years proceeding the statement to resort to mechanical restraint in the 
care and treatment of the insane by them in their hospitals, would not that 
bring you to the belief that it could be actually abolished, if superinten- 
dents were selected who had the faculty (if I may use that term) of succes- 
fully managing their insane patient without it ? 
2. Suppose Dr. Pilgrim, at the head of the great asylum at Willard, 
should say: “It is my belief, however, that the use of mechanical restraint 
is almost never necessary. At least such is my experience with a popula- 
tion of nearly twenty-one hundred cases, many of whom are acute. I have 
had several years’ experience with both symptoms and I, have no hesitancy 
in saying that in my judgment an institution can be much more successfully 
managed without mechanical restraint than it can be with it.” 
Suppose that Dr. Wm. B. Fletoher should say: “In eight years constant 
association with the insane in a hospital with sixteen hundred patients half 
that time and in private practice with only acute insanity the other half, I 
have seen no case where I believe mechanical restraint necessary for the 
safety of the patient or advisable for treatment.” 
Suppose that Dr. Magnan, of St. Anne at Paris, should say, that in all 
his long experience in the care and treatment of the insane, he had never 
yet met a case where mechanical restraint was necessary. 
If Dr. Henry Maudsley should say that he had never used a camisole in 
his life; 
And scores of superintendents, who devote their lives to this humane work, 
should all unite in saying that mechanical restraint was in their opinion 
not necessary to be resorted to in the care of the insane; 
Would not these considerations move you to make a serious effort on 
your own part to endeavor to dispense with it, and would not the fact that 
these men had succeeded in their trusts without it encourage you to hope 
that you might be able to successfully imitate them ? 
3. Is there no force in the statement made by superintendents that the 
excitement, tumult, and explosions incident to the use of mechanical 
restraint retard and interfere with recoveries, and are attended with serious 
danger of aggravating the mental disorder of the patient ? 
And would you not hail with delight any plan by which mechanical 
restraint could be eliminated from hospital treatment, provided in your 
opinion, its banishment would not injure the insane themselves ? 
Your views on this question, in addition to those I have received, would 
be of great interest to me in this important discussion. 
Very faithfully yours, CLARK BELL. 
In answer to my letter, Dr. Prince replied as follows: 
Batavia, III., Nov. 13, 1891. 
Clark Bell, Esq., 57 Broadway, New York. 
My Dear Sir:—Your letter of Nov. 7th was duly received, and would CARE AND TREATMENT OF THE INSANE. 
71 
have been answered sooner, had not very serious illness in my family pre- 
vented. 
In regard to the several propositions laid down by you I would say : 
1. I have the greatest respect for the doctors mentioned, and will not 
deny that they did not find it necessary, for a certain period, to resort to 
the use of mechanical restraint in the care and treatment of their patients. 
This does not necessarily prove, however, that not a single patient under 
their care, who was restrained by manual force, might not have been better 
off, or made more comfortable, had mechanical restraint been used, it not 
having been tried in any of their cases; nor does it prove that hospitals 
managed by physicians who believe in the judicious use of mechanical res- 
traint are not just as ably managed, nor that their patients are not just as 
well cared for. There is sometimes a distinction between what is thought 
necessary for successful management and what is best for the patient in 
each case. 
2. I heartily concur with Dr. Pilgrim when he says that “ the use of 
mechanical restraint is almost never necessary, ” which is equivalent to say- 
ing that mechanical restraint is sometimes necessary. How can he reconcile 
this first statement with the one that “an institution can be much more 
successfully managed without mechanical restraint than it can be with it ” ? 
This, it seems to me, is somewhat contradictory. 
Where a superintendent entirely throws aside a certain method of treat- 
tment, and positively prohibits its future use, it would be very hard for 
him to make up his mind that in a very few cases that particular method 
might possibly have been a little better than the one adopted. 
Dr Magnan, no doubt, was sincere in saying that in his long experience 
he had never met a case where mechanical restraint was necessary. He is 
indeed fortunate if in his experience he is sure he has never had a case that 
could not have been improved or made more comfortable by the use at 
times of mechanical restraint. 
Dr. Maudsley surely could not have learned by personal experience that 
the use of the camisole was improper in every case, if he never used one. 
I never resort to the use of mechanical restraint except in a few cases 
where I feel convinced that nothing else is quite so good. I know from 
personal experience that a few cases, at least, have been benefitted greatly, 
and possibly some lives saved, by substituting mechanical for manual 
restraint, and I have no reason to believe that such cases may not again 
occur in my practice. With this knowledge would I be justified in 
throwing away or burning up all of the hospital restraining apparatus and 
ever after refusing to use it ? 
It may be that in a year’s time and amongst a large number of patients 
the use of mechanical restraint might be indicated in but a single case. 
Yet, in that single case, I would dislike very much being prevented by law 
or by a hospital rule from using that method of treatment that would 
seem to me to be best for the patient. 
3. It is certainly true that there is danger, in many cases, of mechanical 
restraint doing harm; the same danger is to be considered in the use of any 
form of restraint. This is no reason why it should be entirely discarded. 
Harm may result from the improper and injudicious use of many of the 72 
MECHANICAL RESTRAINT IN THE 
remedial measures a physician may use. We hear very little, however, 
about taking from the physician the right to use for his patient such 
remedies as opium, alcohol, &c. 
I would most certainly hail with delight any means or plan that would 
eliminate from hospital treatment the necessity not only for mechanical 
restraint, hot chemical and manual restraint as well, provided, however, 
that in banishing any one of them something better could be provided. 
If I knew positively that in the next twenty years I was to have but one 
patient who in my opinion could be benefitted more by the use of a cami- 
sole or of bed straps than in any other way, I should like to have these 
appliances always on hand for that patient. 
You ask me if I might not be moved to make a serious effort to endeavor 
to dispense with mechanical restraint. I would say that in each case where 
mechanical restraint has finally been resorted to by me all other means 
have been first tried. In nearly every case where restraint has been indi- 
cated, I have personally conducted and assisted in the use of manual 
restraint, and the use of mechanical appliances has only been 
resorted to after the failure of the other means. In the majority 
of cases where mechanical restraint has finally been resorted to as 
being the best thing for the patient, it has proved its usefulness. 
We certainly have no other object in view than the good of our patients 
when we use mechanical restraint, after trying in each case all other means. 
Manual restraint has sometimes failed of its object in my hands. Is it pos- 
sible that those who report never finding it necessary to use mechanical 
restraint have never experienced defeat in the treatment by other means ? 
Unless each case has been made comfortable, and no evil has ever come of 
depending upon manual restraint, in their hands, how can the statement 
that mechanical restraint was never indicated hold good, when it was not 
even tried in a single instance ? 
I repeat that without any doubt I have in a number of instances suc- 
ceeded with mechanical restraint, after faithfully trying and failing with 
other forms. 
It is now several months since mechanical restraint has been used by me. 
The patient was an old lady, reduced almost to a skeleton. Her case was 
one of agitative melancholia; there was constant restlessness, the patient 
never stopping her rapid walk to and fro, crying and moaning, striking her 
head against the door and walls, fearful of being touched by any one. There 
was persistent refusal of nourishment. Manual restraint was tried for a 
time. The patient was made worse by it, and we finally gave it up for the 
following reasons: When held in any way by one or more attendants, the 
patient would become frantic, screaming and resisting without rest. Her 
flesh bruised very easily, and very little pressure was required to darkly 
color the skin. Manual restraint was persisted in, every conceivable form 
of it being tried, but the patient grew more excitable under it. Finally a 
folded sheet was passed about the body, and the ends fastened with safety 
pins under the bed in such manner as to prevent the patient from rolling 
out of bed or assuming the sitting posture. The ankles, after being well 
padded, were fastened, by means of leather anklets and a roller bandage, in 
such a way as to permit of limited movement of the legs. The arms were  CARE AND TREATMENT OF THE INSANE. 
73 
controlled in the same way. The mattress was large enough so as to pro- 
ject over the sides of the bed, the center being a little lower than the sides. 
The patient was thus completely protected from danger of bruising. The 
room was darkened, the patient given nourishment often without great 
trouble, and the body was frequently bathed with alcohol. It was not long 
before the patient’s excitement began to subside, and she finally made a 
good recovery. I feel confident that had not mechanical restraint been 
used, the patient would have died of exhaustion. The record for non- 
mechanical restraint would possibly have been better, but how about the 
probable final result ? This is no fancy case. It is only one of several 
similar experiences I have had in this particular class of cases. Would 
you, my dear sir, advise me to refrain in the future from the treatment 
described above, the conditions being the same ? 
I could cite cases differing in form of insanity, where I have felt con- 
vinced, after trying all other means known to me, that to deprive 
the patient of temporary restraint by muffs, or camisole, would be 
nothing short of inhumanity. It grieves me that able men condemn a 
method because it has been abused, and assert that the adherence by a phy- 
sician to the method condemned is a proof of his incapacity. 
Very sincerely yours, 
L. H. PRINCE. 
Dr. G. R. Trowbridge, Assistant Physician at the State 
Hospital for Insane, at Danville, Pa., so long presided over 
by Dr. Schultz, a member of this Society, whom I addressed, 
and who had published a monograph favoring restraint, re- 
plied as follows: 
The State Hospital for the Insane, 
Danville, Pa., Nov. 6, 1891. 
President of the Medioo-Legal Society : 
Dear Sir:—Many thanks for your kind invitation to express my views 
on the subject of “Mechanicai Restraint Among the Insane.” 
The two sides of this question may be looked upon with approval or dis- 
approval, and certainly present ample scope for an extended argument. 
The idea of a mechanical restraint might, to some unacquainted with the 
needs of the case, seem a rather barbarous custom, but how those connected 
with institutions for the care and treatment of the insane can advocate an 
absolute non-restraint is beyond my imagination, and I am inclined to con- 
sider the idea is advanced more in the spirit of the politician than in that 
of the true alienist. 
The point of the matter is right here. As long as insanity assumes the 
violent forms it does in so many of our cases, just so long will it be neces- 
sary to employ some form of restraint, and the question arises, ‘ ‘.Shall it be 
mechanical, manual, or chemical ? ” 
The insane asylum is in itself a form of restraint; its inmates are a class 
of irresponsible beings, often controlled by strange delusions, which in turn 
give rise to violent and dangerous acts, and, consequently, society demands, 74 
MECHANICAL RESTRAINT IN THE 
for their own and the good of the individual, that the insane should be 
kept under restraint. 
That there is often necessity for an additional restraint among these 
people, I am fully convinced, and, as I have said, the question arises, 
“ What shall we use ? ” For my own part, I am heartily in favor of “me- 
chanical restraint,” carefully and judiciously employed, and I do not think 
we have reached a time when it can be totally discarded. 
I grant that there is abuse of “ mechanical restraint” in many of our in- 
stitutions, but in these cases it is not the fault of the restraint, but of a 
careless medical officer. 
We all know that some hospitals claim an “absolute non-restraint” 
system. Is this strictly speaking the truth, or do they retire safely behind 
a bottle of morphine or hyoscine and a hypodermic syringe, and from its 
friendly protection make their stand for the abolition of mechanical res- 
traint ? I know such to be the case in one of our so-called non-restraint 
concerns, and I am inclined to think it is the case in a large number of 
them. The substitutes for mechanical restraint are manual or chemical, 
and I fail to see where the advance has been made. I cannot imagine any- 
thing more harmful and annoying to patients than to be continually poking 
a hypodermic syringe into them for the purpose of restraining them. This 
instrument has its place in the hands of a conscientious alienist, but I am 
of the opinion that in our institutions, where there is a system of non-res- 
traint, the hypodermic syringe should be taken from the hands of the medi- 
cal officers, for in these cases its authorized use leads to its abuse. 
As for manual restraint, is it any better thau chemical ? I cannot imag- 
ine anything more disgusting than to have three or four, or even a half- 
dozen, attendants hanging to an excited patient with the idea of controlling 
him. It is exasperating to the patient and attendants, and in the major- 
ity of cases will result in injury to one or the other. I have tried it, and 
have laid it aside as an exploded idea. 
I have had cases under my charge which I know have been greatly aided 
in their recovery by the use of a careful restraint, and as long as I can see 
good results arise from its use, I shall decline most emphatically to vote it 
a relic of barbarism. 
As medical officers in State hospitals for the insane, we are bound to 
care for these unfortunates in the safest manner, and if, through the desire 
of making a record of a non-restraint, we should allow a patient to take 
his life, the one having such a catastrophe should be made a subject for 
justice to deal with. 
One more thing before I close. I should like to inquire from these al- 
leged and self-constituted “ reformers ” how they do manage certain cases 
which all hospitals for the insane contain, if they do not use some form of 
restraint ? 
Let us consider the matter of mechanical restraint carefully before we 
discard it. 
Yours very truly, 
G. R. TROWBRIDGE. 
I also send you a reprint of an article I wrote on this subject some time 
ago. G. R. T, CARE AND TREATMENT OF THE INSANE. 
75 
The monograph of Dr. Trowbridge is interesting, but too 
lengthy for this discussion. I make, however, a few extracts 
from it, which are of importance, in my opinion. 
The monograph was read before the Montour County 
Medical Society, of Pennsylvania, and published in the 
Buffalo Medical and Surgical Journal March, 1891. 
Dr. Trowbridge gives the following definition of “ Res- 
traint,” not using the term “ Mechanical Restraint:” 
By the word “restraint,” as it is used by the alienist of to-day, I under- 
stand the depriving of voluntary action of an individual, either for his own 
or the safety of others, or for his mental, moral, and physical good, the in- 
dividual being irresponsible for his conduct. 
Dr. Trowbridge quotes Hon. William P. Letchworth, in 
his work, “ Insane in Foreign Countries,” as to the methods 
employed in some foreign asylums half a century ago. I 
quote the statements: 
The methods of restraint in common use included iron hand-cuffs con- 
nected with chains to a leather waist-belt; leathern hobbles locked around 
the ankles, which permitted the patient to shuffle his feet, but impeded 
his movements so that he could not walk; iron hand-cuffs with chains, 
which passed through fastening locks at the sides of heavy ‘ ‘ tub bed- 
steads,” filled with istraw, boots made of ticking, with rings and chains 
which passed through fastening locks at the bottom of the bedsteads. 
I further quote, from the same monograph, Mr. Letch- 
worth’s report as to Gheel, in Belgium: 
At Gheel, Dr. Peteers has the following methods: (i.) A broad padded 
belt or band, five inches wide, for locking around the upper part of the 
arms. In this belt is an iron loop, through which passes a strap for secur- 
ing the patient to the side of the bed. (2.) Two padded leather bands, 
three inches broad, connected in the center by a link two inches long. 
These are designed for the ankles of the patient. To each is attached a 
loop of iron, through which a strap is passed and fastened to either side of 
the bedstead. (3.) Two padded soft leather wristbands, three inches wide, 
separating the wrists about eight inches. Dr. Peteers said these were 
scarcely ever used. (4.) A broad leather belt encircling the body, with 
two leather pockets in front for the hands, which are secured in their 
position by wristlet straps. Extending from this belt across the shoulders, 
suspender fashion, are straps which retain in position and relieve the 
weight of the belt, which locks at the back. 
Dr. Trowbridge quotes the views of Dr. Daniel Nicholson, 
a member of the Medico-Legal Society, and now superin- 76 
MECHANICAL RESTRAINT IN THE 
tendent at Broadmoor, as published in Journal of Mental 
Science, July, 1890, as follows: 
Dr. Nicholson,* of the Broadmoor Criminal Asylum, Eng- 
land, says: 
The question as to the employment in lunatic asylums of what is known 
as “mechanical restraint,” occupied a considerable amount of public 
attention last year. The legitimate or justifiable use of mechanical 
restraint is one thing, the authorized abuse of it another. The sanction 
of modern times in this country is clearly against the use of mechanical 
restraint; and very properly so in recollection of the extent to which it 
was carried in days gone by. The existing practice is, as a matter of fact, 
in accordance with this sanction ; and the exceptions when this form of 
restraint is used for other than surgical reasons, are sufficiently few to 
afford the best proof of the rule. Besides sanction and practice, an ele- 
ment of sentiment has crept into the matter which would fain make it of 
the nature of a crime to use mechanical restraint at all, unless, perhaps, in 
surgical cases. 
Mechanical restraint is practically unknown at Broadmoor. It was, I 
believe, used on a few occasions in the early days, but for over twenty 
years it has been found possible to do without it. The comparatively 
numerous staff of attendants at this asylum enables exceptional strength 
to be brought to bear when occasion requires it; but my own feeling in 
the matter is that in a case of continuous and long-sustained maniacal 
violence, with an activity avowedly and determinedly homicidal, it is 
possible to carry the non-restraint principle (so-called) too far and at too 
great a cost. Few people who are not engaged in it are able to estimate 
the wear and tear of nerve and heart which a tussle with a desperate luna- 
tic of this sort means to the attendants, apart from the risk of positive in- 
jury either to the patients or warders. And when this struggle has not 
only to be anticipated, but to be engaged in, several times a day for a 
lengthened period, the justifiability and humanity of simple, effective and 
safe mechanical restraint become apparent. 
If ever it should be my lot to be a lunatic, such as the one whose treat- 
ment is here in question, I hope my good friend, the Superintendent, who 
has me in charge, will not be too squeamish about recent traditional usage, 
but will see that I am checked by the minimum but necessary amount of 
restraint to insure my own safety and that of others. On the one hand, I 
do not wish to think that under any circumstances I should be the means 
of inflicting injury upon my attendants; on the other hand, I would infi- 
nitely prefer mechanical restraint to the long continued manipulations, 
however skilful and friendly, of four or more attendants heaped upon my 
prostrate form The evil to be feared with regard to mechani- 
cal restraint is lest its legitimate use should lead to its authorized abuse. 
This could never happen if, in every case, the physicians themselves were 
to order it to be used, and that only after a careful and complete personal 
* Journal of Mental Science, July, 1890. CARE AND TREATMENT OF THE INSANE. 
77 
investigation. When the restraint is applied by underlings andiits use 
afterward sanctioned by the responsible officers, we have the authorized 
abuse which is altogether wrong and reprehensible. 
And Dr. Trowbridge closes his paper by the following 
statement: 
In the report of the Committee on Lunacy in this State (Pa.) for 1889, 
the Secretary mentions the fact that there had been ‘ ‘ no mechanical res- 
traint” used in the female department of the Norristown State Hospital 
for the Insane for “the past year,” commends the fact, and asks “Why 
not the same in other hospitals ? ’ ’ 
This inquiry is certainly a very strange one. Lunatics differ as well as 
sane people, and have to be treated accordingly. The female department 
of Norristown is to be congratulated on having such an easy i class of the 
insane to deal -with. 
This matter of ‘ ‘ mechanical restraint ’ ’ should be carefully considered 
before it is voted a relic of barbarism. 
The following reply was received from W. Thornton 
Parker, M. D., one of the Medical Examiners of Rhode Is- 
land : 
Manchester-by-The-Sea, Mass., Nov. 3, ’91. 
Dear Clark Bell: 
Your favor is received. I have read Dr. Diller’s paper with great in- 
terest, and it seems to me very fairly stated, but the subject cannot be dis- 
cussed so hurriedly. Too much is at stake. Your work is of the greatest 
importance, and the wisdom of your great Society will, even when united, 
find the “ art long, and the time fleeting.” Without cant, much of suc- 
cessful government can be carried on with kindness. I have had con- 
siderable experience myself, and I am fully convinced of this, even in the 
care of homicidal and suicidal cases. To take the opposite position is to 
encourage all that is brutal in our attendants, and human nature is at best 
“of the earth, earthy.” We aim at the accomplishment of the divine 
command, “Be merciful,” and it is not wise or brave to say “ we cannot.” 
As I said before, you are engaged in a great work, and you must not come 
down. It will not be settled in the near future, but you know great progress 
has been made already, and is being made, and more can be made. I am 
deeply interested. There is plenty of cowardly bullying among Superin- 
tendents, assistants, and nurses. It differs in its degree, and in its 
methods, but the evil, the sore, is still there, still festering, still unhealed. 
Manliness, love of fair play, divine love, which is the essence of true 
manhood, steps forward between prisoner and gaoler, and says to-day, 
* ‘ Thus far, but no farther. ’ ’ 
Faithfully yours, 
W. THORNTON PARKER. 78 
MECHANICAL RESTRAINT IN THE 
Dr. Henry M. Hurd was for eleven years Superintendent of 
the Eastern Michigan Asylum, at Pontiac, Mich. Two years 
since he became Superintendent of the Johns Hopkins 
Hospital, and Professor of Psychiatry, at the Johns Hopkins 
University. 
I give his reply: 
The; Johns Hopkins Hospital, Baltimore, Dec. i, 1891. 
To the; Editor ok the Medico-Legal Journal: 
Dear Sir:—The value of the principle of non-restraint is too obvious to 
require any argument. Mechanical restraint never has been resorted to 
in any asylum without sooner or later begetting an abuse of it. Patients 
are more comfortable without restraint, and get well more rapidly when 
it is not resorted to, either as a rule or an occasional practice. The rela- 
tions between patients and attendants, and between patients and medical 
officers, are more harmonious when non-restraint is the rule. I can read- 
ily imagine a case which might be more conveniently cared for by using 
restraining apparatus, but I do not regard such mechanical restraint as 
absolutely essential to proper care, nor as helpful even to such a case in 
the long-run. 
In matters of asylum policy, however, the largest liberty should be ac- 
corded to every officer. He who believes in non-restraint should not have 
his motives or his practice impugned; nor, on the other hand, should the 
believer in “judicious restraint’’ be placed beyond the pale of charity. I 
have tried both, and I believe non-restraint to be preferable. 
Very respectfully, 
HENRY M. HURD. 
57 Broadway, New York City. 
Dr. Moncure has been for some years at tlie head of the 
Eastern Lunatic Asylum of Virginia, at Williamsburgh. He 
is a member of the Medico-Legal Society, and a careful 
student of Mental Medicine. His letter is as follows: 
Eastern Lunatic Asylum, Williamsburg, Va., Nov. 11, 1891. 
Dear Sir:—I have read the article written by Dr. Theodore Diller 
dated Sept. 28, 1891, and though an advocate for non-restraint as the guid- 
ing rule in insane asylums, I must say that I cordially agree with him. 
There are cases where judicious restraint inflicts less injury and is far 
more humane than either chemical or manual restraint. I have only had 
three cases under restraint for the last six years, with an average of more 
than four hundred patients. These are put under restraint only to pre- 
vent injury to themselves, which is sure to result from any other kind of CAEE AND TREATMENT OF THE INSANE. 
79 
treatment. I think that the less mechanical restraint, except in these 
rare cases, the better for the patient. 
Respectfully, 
JAS. D. MONCURE, 
Sup’t E. D. Asylum. 
Dr. William Okange, for years Superintendent of the 
great English asylum for insane called criminals, at Broad- 
moor, England, and who, since his retirement from that posi- 
tion, has been one of the alienists selected by the Crown to 
decide on the insanity of homicides, and an active member 
of the Medico-Legal Society, sends the following promise of 
a more extended letter upon this subject: 
12 Lexham Gardens, W. London, October 28, 1891. 
Dear Mr. Bell: 
I write a line to say that I am away from London for a few days, but I 
shall be at home again by the end of the week, when I will write to you 
again upon the subject of your letter, and the enclosure of Dr. Diller. 
The statement with which Dr. Diller commences his article—to the 
effect that persons who advocate non-restraint do so because it is politic, 
rather than because it is right so to do—would not, I fear, apply to Eng- 
land, just at present. On the contrary, the politic thing, just now, in 
England, is to defend the use of mechanical restraint. It almost looks as 
if the tendency of the pendulum to swing from one extreme to another 
were the fundamental principle of human action. 
I dare say you may have seen the report of a discussion by the English 
Medico-Psychiatry Association in November, 1888, reported in the Jour- 
nal of Mental Science for January, 1889. 
Hoping to write to you again at the end of the week, believe me, 
Yours very truly, 
W. ORANGE. 
Clark Bell, Esq., 57 Broadway, New York. 
From the foregoing replies, it seemed that the question 
should be regarded and discussed from a more practical 
standpoint, and I addressed the following letter to other 
Superintendents, from some of whom I received responses : 
Office of the President of the Medico-Legal Society, 
No. 57 Broadway, New York, December, 1891. 
Dear Sir:—The enclosed paper of Dr. Diller was read at the November 
meeting of the Society, and replies from Drs. P. Bryce, P. M. Wise, 
Henry Maudsley, of London, D. Hack Tuke, Charles W. Pilgrim, G. Alder 
Blumer, Carlos F. MacDonald, John B. Chapin, W. W. Godding, W. B. 80 
MECHANICAL RESTRAINT IN THE 
Fletcher, L. A. Tourtellot, G. R. Trowbridge, James Olmstead, H. P. 
Stearns, of Connecticut, Gershom H. Hill, of Iowa, Richard Dewey, of 
Kankakee, Selden H. Talcott, of New York, and many were received 
from others, including Prince, of Batavia, 111.; Curwen, of Pennsylvania; 
Wallace, of Texas; Parsons, of New York; Parker, of Rhode Island; 
Burr, of Pontiac, Mich.; Steeves, of New Brunswick; Moncure, of West 
Virginia; Hughes, of St. Louis, and many others. 
I was instructed by the Society to publish these replies in the Journal, 
and shall be glad to include yours. While in New York mechanical res- 
traint is not used, and in most of the higher class of asylums elsewhere, it 
is a fact disclosed by these discussions that it is practiced still in quite a 
large number of American asylums, and that an effort is made, endorsed 
by men of position, to justify its use, and to inaugurate a doctrine that it 
would be safe to take up and justify mechanical restraint. Judicious res- 
traint seems to be the watch word of a proposed practice, based on discre- 
tion of the Superintendents, which would depend npon the temperment 
of each and the characteristics and opinions of each, and in many cases 
go back to the barbarities of the recent past. 
I wish your views on this question, and especially upon the following 
propositions: 
1. If Superintendents like Bryce, Wise, Fletcher, Blumer, Pilgrim, 
Alice Bennett, J. C. Shaw, and many others in American asylums, and 
Drs. William Orange, Daniel Nicholson, Dr. Needham, and the great 
body of Superintendents of British asylums for the insane, can success- 
fully conduct their hospitals for the insane without recourse to mechani- 
cal restraints, is it not time for all to unite in the statement that it cannot 
be longer regarded as necessary, much less indispensably so? 
2. Should it not be the duty of Superintendents of asylums to inform 
themselves of the methods by which the principles of “ non-restraint ’' 
have been successfully accomplished by these Superintendants who have 
succeeded in dispensing with restraint altogether? 
3. Should not all agree, in view of the public feeling against its use, the 
well-known tendency to its abuse where used, and the strong tendency 
and bent towards its improper use when left to the individual discretion 
of Superintendents, many of whom are without any experience in the 
care of the insane without it, that the time has arrived when Superin- 
tendents should make an earnest endeavor to see, by experimental trial, 
and by learning of those who have succeeded, to see if it cannot be dis- 
pensed with, or reduced to its minimum limits? 
An early reply will be regarded as a favor. 
Very faithfully yours, 
CLARK BELL. HON. EDWARD W. SCUDDER, 
Supreme Court of New Jersey. 
HON. BENNETT VAN SYCKEL, 
Supreme Court of New Jersey. CARE AND TREATMENT OF THE INSANE. 
81 
Dr. Wm. Orange is one of the most honored and influen- 
tial names among British Alienists. For many years super- 
intendent of the great Asylum for the Insane called Criminals, 
at Broadmoor, he has occupied a close relation to the Law 
Officers of the Crown. He is frequently selected as an 
expert by the Crown on questions of commutation of sen- 
tence of death. 
He wTrites as follows: 
12 Lexham Gardens, London, W., 
December 28, 1891. 
To Clark Bell, Esq. 
Dear Sir:—In compliance with your request I send you a few lines on 
the subject of the use of mechanical means of bodily restraint in the treat- 
ment of insane persons ; although, in so doing, I am very well aware that 
I have nothing new to say upon the subject, nor, indeed, anything which 
has not been much better said, over and over again, in the past. 
I have read the extract from Dr. Bryce’s report, published in the March 
number of the Medico-Legal Journal, and also the letter from Dr. 
Theodore Diller, the proof of which you have been so good as to send 
to me, and I cannot for a moment doubt that, if these two papers are read, 
side by side, so that the manner and matter of the one may be compared 
and contrasted with the manner and matter of the other, there need be 
little fear as to the verdict. 
Dr. Bryce sets forth his belief in these words : ‘ * That the insane, in public 
hospitals, can be controlled and treated more humanely, and with better 
results, without the use of strait-jackets, camisoles, muffs, wristlets, 
restraining chairs, bed-straps, crib-bedsteads, or any other of the various 
appliances known as restraining apparatus.” And then he goes on to say 
that, for ten years, at the Alabama Asylum, with a household averaging 
nearly a thousand patients, “there has been no resort whatever to any 
species of mechanical restraint for either surgical or other purposes ; ” and 
further, that there has not “ occurred a single case, in the wards of the 
hospital, during this long period, which seemed to justify or require its 
use. ” Thus, in plain language, does Dr. Bryce place on record his experience, 
and, for my part, I have only to say that, in this matter, my experience 
corresponds entirely with his. 
Throughout the period of sixteen years, from 1870 to 1886, during which 
I held the office of Medical Superintendent of the Broadmoor Asylum, 82 
MECHANICAL RESTRAINT IN THE 
which is an asylum established by the Government for the care and treat- 
ment of criminal lunatics in England, I did not find it either necessary or 
desirable to have recourse to any of the appliances enumerated by Dr. Bryce, 
in the extract quoted, nor did there, throughout that period, occur any case 
in which, afterwards, I had any reason whatever to regret the non-use of 
such means of treatment. 
Such being my experience, it can readily be imagined that I give my most 
cordial assent to the terms in which Dr. Bryce states his belief in this mat- 
ter. 
If we now turn from the article of Dr. Bryce to that of Dr. Diller, we 
find that the contrast in manner and tone is as great as it is in matter. 
It would be scarcely fair to assume that the tone of Dr. Diller’s letter is 
characteristic of the school to which he belongs; and it may be hoped that 
there may be many amongst those who, to a greater or less extent, agree 
with the opinions which he expresses, who will feel keen regret at the gen- 
eral tone of his letter, and who will take an early opportunity to avow such 
regret. Dr. Diller, it will be observed, begins his letter by imputing the 
most unworthy motives to those who differ from him. and he does this in 
in a manner so offensive as to render the task of taking notice of his letter 
by no means a pleasant one ; and it is to this cause, indeed, that I must, 
to a great extent, aseribe the delay, on my part, in fulfilling this task ; for, 
if there really be any one who, after reading the writings of Conolly, 
could venture to make so monstrous a suggestion as that that humane phy- 
sician, when advocating the disuse of mechanical means of bodily restraint, 
in the treatment of insane persons, was advocating, not so much what he 
believed to be right, as what he thought to he politic, I, of my own free 
will, should prefer to avoid entering into a discussion with such an one. 
As you, sir, however, have invited comments on this letter, which begins 
in a manner so unfortunate, I comply, although I must crave permission to 
make those comments very brief. 
Dr. Differ, having commenced his letter with a gratuitous insult to those 
who venture to differ from him, goes on, in the next place, to sneer at the 
value of kindness in the treatment of patients suffering from mental dis- 
orders ; and he ventures on the observation that “ kind words,” in certain 
cases, “ would do about as much good in deterring these patients, as they 
would if addressed to a Dakota blizzard in mitigating its force.” And 
here we have a very good example of the danger that is incurred by indulg- 
ing in the use of illustrations. What, we may ask, has a Dakota blizzard 
to do with the question? and what similarity is there between a Dakota 
blizzard and a patient suffering from mental disorder? Does Dr. Diller 
wish us to understand that, although “ kind words ” would have no effect 
in mitigating the force of a Dakota blizzard, yet that complete success in 
this matter would be attained by the use of “a merciful restraining appa- 
ratus ? ” If this is really what Dr. Differ wishes us to understand, it would 
certainly be interesting to be favored with an opportunity of examining the 
kind of ‘ ‘ merciful restraining apparatus ” which Dr. Differ has been suc- 
cessful in applying to a Dakota blizzard; but if, on the other hand, it 
should appear, on inquiry, that the attempts made by Dr. Differ to mitigate 
the force of a Dakota blizzard by means of a “ merciful restraining appa- CAKE AND TKEATMENT OF THE INSANE. 
83 
ratus” have been attended with no greater success than has attended the use 
by him of “ kind words,” what becomes of the illustration? I must con- 
fess that I find it impossible to regard the letter of Dr. Diller as being one 
which calls for any serious reply. 
It will not escape observation that Dr. Bryce, in his remarks, is speaking 
of the treatment of the insane in public hospitals, by which expression it 
may be assumed that the writer is speaking of their treatment in institutions 
duly adapted for the purpose in view, both as to staff and as to construction. 
The possibility is always recognized that, under circumstances which are 
not favorable for the satisfactory treatment of persons suffering from 
mental disorder, it may become necessary, in some cases, to have temporary 
recourse to the use of mechanical means of restraint; not, most certainly, 
because such means are the best absolutely, but only because they are the 
best under the unfavorable circumstances. Where the choice is limited to 
a choice of evils, the best course is, doubtless, to choose the least. 
Believe me, Dear Sir, yours very faithfully, 
W. ORANGE. 
Dr. Ralph L. Paksons, a physician of extended experi- 
ence in charge of public and private asylums, for years a 
member of the Medico-Legal Society, and one of its former 
Vice-Presidents, now at the head of a private asylum at 
Sing Sing, New York, responds to my inquiries as follows: 
Dr. Parsons’ Private Home for Nervous Invalids, 
Greenmount, November 10, 1891. 
To the Editor of the Mkdioo-Legal Journal : 
Dear Sir:—The question regarding the use of mechanical restraint in the 
management of the insane is so broad and far-reaching that it cannot be 
satisfactorily answered within the scope of a short letter. In fact, many 
questions are involved which require separate answers, as: 
1. Is mechanical restraint ever admissable? The answer to this must 
evidently be in the affirmative, as when the best endeavors of all the persons 
available to undertake the care of the insane person are not sufficient to 
prevent him from doing injury to himself or others ; and this lack of 
ability may depend on a lack of physical strength, or a lack of skill, one or 
both of which conditions are likely to obtain when the patient is not within 
the walls of a hospital. 
2. Is mechanical restraint ever admissable at a hospital for the insane ? 
If there were an insufficient number of helpers, sufficiently skilled and suf- 
ficiently strong, to prevent the insane person from doing an injury to him- 
self or to others, the answer must also be evidently in the affirmative. As 
many as six or eight persons, well skilled in the management of the insane, 
are sometimes required for the care of an insane person, when neither me- 
chanical restraint, nor drug restraint, which is a form of mechanical re- 
straint, is in use. And this lack of skilled help was the rule, rather than the 
exception, in asylums in former times, and is liable to occur at what are 
now considered as well equipped hospitals for the insane; for it is essential 84 
MECHANICAL RESTRAINT IN THE 
to the proper care of an excited, dangerous patient that the attendants who 
undertake his care by their physical strength and powers of moral suasion 
or tact be sufficiently numerous and that they have abundant opportunity 
for rest, lest they become so exhausted as to lose their power of self control 
or their ability to perform their duties in a proper manner. 
3. Is mechanical restraint ever advisable at hospitals for the insane 
which are so thoroughly equipped that all the skilled assistance needed is 
always at hand? Under this state of things it is safe to say that the patient 
can always be managed successfully without the use of mechanical restraint, 
and that usually this method is the best. But yet it would be very rash for 
any one to say that manual restraint alone would, in all cases, be bet- 
ter for the individual patient than mechanical restraint. The skilled phy- 
sician in charge should be so untrammeled by rules or by sentiment that he 
could freely decide this question in any individual case. And it may 
safely be asserted that most physicians would at some time have under their 
care patients whom they could manage better by means of mechanical 
restraint than without. That some other physician thought he could man- 
age better without such restraint, or that he really could so manage, would 
not alter the case. In every branch of medicine, or of any other calling, 
there are individuals whose skill, in some particular, exceeds that of their 
fellows ; but this does not at all prove that their fellows are unskilled. 
4. But there are objections to the use of mechanical restraint based on the 
theory that it tends to take the place of, or to prevent the employment of, 
such curative measures as may be indicated; and also that it tends to 
diminish the efficiency and assiduity of physicians and nurses in their 
attentions to the patient. It must be admitted that this danger exists. A 
similar danger exists in the use of narcotic drugs. But a danger of this 
sort should not be allowed to prevent the doing of what is for the best in 
any individual case. 
The inference from the above would be that, practically, with average 
expert skill and with all needed help, mechanical restraint is advisable only 
in very rare and infrequent cases, but yet that even under this state of 
things it is sometimes advisable; while in lack of such help and skill 
mechanical restraint is not infrequently advisable. 
RALPH L. PARSONS. 
Dr. James H. McBride, medical superintendent of a pri- 
vate institution in Wisconsin, thus replies: 
Milwaukee Sanitarium for Nervous Diseases, 
Wauwatosa, Wisconsin, December 31, 1891. 
Clark Bell, Esq., 57 Broadway, New York : 
Bear Sir:—Your letter is at hand, and I enclose the re-print sent me. 
I think it is useless to discuss the question of restraint for the insane. It 
seems to me that nothing new can be said on this subject, and, as I have 
said once in print, it is one which, from its very nature, will never be set- 
tled. The claim that mechanical restraint should not be used at all, because 
if used it would be abused, is to me a very absurd one. The same argument 
would apply to chloral, hyoscine, and, in fact, to every drug that is usually CARE AND TREATMENT OF THE INSANE. 
85 
used in the treatment of the insane ; indeed these drugs are much more apt 
to be abused than restraint, and when abused, the harm that results, much 
more lasting. 
Very truly yours, 
J. H. MoBKIDE. 
Dr. Richard Greene, one of tlie leading English superin- 
tendents of county asylums, replies as follows : 
County Asylum, Beery Wood, Northampton, 
13th January, 1892. 
Dear Sir :—My views on the question of restraint or non-restraint have 
not altered during my experience of twenty-two years in county asylums. 
I believe it to be possible to treat the insane without restraint; but I do not 
believe it is always desirable to do without restraint; therefore I occasion- 
ally resort to it. Perhaps I should say I rarely resort to it. During the 
year 1891, with an average of 800 patients, I used restraint on one patient, 
the means used being the stitching of the sleeves of his coat to the sides of 
the coat. The patient was beating his cheeks to a jelly, and I considered 
this preferable to the employment of a couple of attendants to control 
him. 
The Commissioners in Lunacy, in their Blue Book for 1888, when speaking 
of restraint, say, “We could not condemn its employment in every case 
and without exception, for to do so would, we thought, be adverse to the 
interests of the insane themselves.” This view is, I think, held almost 
universally by the medical superintendents of our county asylums. Dr. 
Gardiner Hill, medical superintendent of the Wandsworth Asylum, says in 
his report for 1890, “ Because this form of treatment is unpopular, it is no 
reason why it should be discontinued altogether, for there are exceptional 
cases in which the use of restraint may be fully justified.” 
By the way, you are wrong in attributing to Conolly the introduction of 
our non-restraint system. It was Gardiner Hill, the father of the above- 
mentioned Dr. Gardiner Hill, who was the first to abolish restraint. You 
will find this part of the history of non-restraint worked out by Dr. 
Richardson in the Asclepiad for the third quarter of 1887; and I referred 
to the question in a paper of mine which appeared in the Universal Review 
for August, 1889. 
I remain very faithfully yours, 
RICHARD GREENE. 
Dr. C. B. Burr is a superintendent of long and extended 
experience in charge of one of the largest hospitals for the 
insane in Michigan, and his views are entitled to great 
weight, both from his practical knowledge, and from his long 
experience in contact with the insane. 86 
MECHANICAL RESTRAINT IN THE 
Eastern Michigan Asyeum, Pontiac, Mich., 
November 16, 1891. 
Ceark BEEE, Esq. , Editor Medico-LEGae Tournae: 
Dear Sir:—Your polite note is received. I take pleasure in complying 
with your request to give my views in the matter of restraint in the 
management of the insane. 
The institution with which I am connected has been committed to non- 
restraint as a principle for many years, and as a practice, restraint was 
virtually abandoned long ago. While committed to this principle, how- 
ever, and believing it to be eternally right, it has not been pursued as a 
hobby, and the wisdom of mechanical restraint in occasional cases has 
been persistently set forth and defended. 
The principle of non-restraint is wise and right— 
1st. Because of the pleasanter relation and better feeling existing be- 
tween attendants and patients where mechanical restraint is not applied. 
The element of personal antipathy and antagonism so apt to to be 
present in the mind of a patient where mechanical restraint is used—par- 
ticularly where a high degree of force is necessary to apply it—strains 
the subsequent relation of the patient to the attendant, and creates a feel- 
ing of soreness and disaffection which is apt to be enduring, and which on 
occasions materially interferes with the patient’s recovery. 
2d. Because of the danger lurking in the indiscriminate use of restraint. 
The confinement of the limbs of a patient suffering with acute mania, 
for example, creates physical pain, lameness and discomfort, with resulting 
irritability. Excitement is prolonged and intensified, and the restless- 
ness which springs from disordered brain action, not being given vent or 
diverted into healthy channels, increases brain perturbation, and may be 
the occasion of more violent excitement, acute exhastion, and death. 
3d. Because the adoption of non-restraint as a principle develops the 
resources of attendants. 
Given restraint as a frequent resource in the management of patients, 
it is the first expedient thought of, and is applied early and often. The 
insane energy which it should be the duty of the attendant to divert into 
useful ways, or repress within reasonable limits, is suppressed altogether. 
The attendant no longer sets his mind to the work of devising ways and 
means for individualizing his patients and meeting emergencies. A 
patient, for example, breaks out a light of glass, and is restrained. The 
impulse which occasioned the breaking of the glass is relieved by the act 
of destructiveness. To restrain him after the act is committed, as a rule, 
merely serves the purpose of increasing his irritability, and encouraging 
a spirit of lawlessness and violence. The impulse being relieved by the 
act which it occasioned, to restrain is equivalent to locking the barn after 
the horse is stolen. The recourse to restraint not occurring to the attend- 
ant, he devises ways and means to divert the patient’s mind, when at 
some future time, he is threatened with recurrence of the impulse. He 
closes the stable door in time to prevent the theft. 
4th. Because restraint promotes habits of degradation and untidiness. 
The restrained patient is helpless. He cannot go to the closet without the CARE AND TREATMENT OF THE INSANE. 
87 
assistance of the attendants, and even if his mental operations are of such 
a character that he is able to ask for what he requires, he is perhaps de- 
terred from preferring the request by the antagonism toward the attendant 
which the application of restraint has aroused. Further, if he is perverse, 
and bent (as so many patients are under those circumstances), on making 
the lives of the attendants uncomfortable, he will deliberately soil his 
clothing to create trouble. 
5th. Because of the danger of the formation of the habit of restraining. 
A patient will perhaps be restrained one day because circumstances 
have required this action on the previous day, while the mental condition 
of the patient may be wholly different. A spirit of timidity arises in the 
mind of the attendant, and he has not the degree of confidence in his 
patient which is so necessary to their friendly relations. He restrains 
him one day because of the fear that he may do something which he has 
done the day before, much to the patient’s dissatisfaction, humiliation, 
and irritation. 
6th. Because of the lack of moral or restraining effect upon the minds 
of patients or their associates where the use of restraint is frequent. 
In a non-restraint institution a patient regards the application of 
mechanical restraint, used only at rare intervals and as a last resort, as an 
unenviable distinction, and avoids, as far as lies in his power, the neces- 
sity for its subsequent use. 
7th. Because of the danger which exists of the use of restraint exciting 
in the mind of some susceptible patient a desire to imitate. 
An hysterical, emotional girl, for example, who prefers any distinction, 
however unenviable, to being ignored, will sometimes deport herself in 
such a way as to necessitate restraint, provided she sees it used in other 
cases. 
Restraint is, in my judgment, absolutely necessary and unavoidable— 
1st. In certain surgical cases. 
The importance of the use of restraint in certain surgical cases to pro- 
mote quiet and to prevent the patient from disarranging important surgical 
dressings, re-opening wounds, and removing splints and bandages, will 
hardly be denied. No form of manual restraint can in such cases take 
its place. 
2d. It is also absolutely necessary and unavoidable in a very limited 
number of cases with homicidal tendencies. 
I should strictly limit its application to such cases as possess great 
strength and are persistently and determinedly homicidal. Where, not- 
withstanding employment, diversion, the adoption of various moral 
measures, and the exercise of all reasonable means to change the patient’s 
mental action and substitute for the homicidal propensities amiable char- 
acteristics and natural impulses, efforts are unavailing, and where the 
great strength of the patient renders struggles with him dangerous to the 
life or health of himself or his attendants, I believe restraint to be entirely 
necessary and defensible. 
3d. It is necessary and unavoidable in a certain number of suicidal 
cases, and in cases where the propensity to self-mutilation exists, particu- 
larly if delusions are strong and persistent. 88 
MECHANICAL EESTRAINT IN THE 
If a patient displays these tendencies, and has physical strength, deter- 
mination and cunning to the extent that constant personal attention dur- 
ing the day-time and the presence of a night-nurse during the night are 
not sufficient to deter him from yielding to his impulses, restraint is 
practically indispensible. 
4th. It is also necessary and unavoidable in prolonged, furious excite- 
ment, such as is seen but few times in a long asylum experience, where 
manual restraint exercised by three or four attendants is insufficient to 
keep the patient within bounds, prevent him from dashing himself to the 
floor or agaisnt the wall or through the window, in his unreasoning and 
terrible frenzy. 
Restraint is possibly expedient and justifiable in aggravated cases of 
destructiveness. 
Here much caution should be exercised. In my experience, not one 
case in a thousand presenting destructiveness as a symptom would be a 
proper subject for restraint. Every expedient should be tried, and many 
tried, re-tried, and tried again, before the last resort (restraint—a confes- 
sion of failure), is made use of. 
On the day that this is written, the Eastern Michigan Asylum has in 
restraint one patient in 940 cases under treatment, and for the reason last 
referred to. At the time I began my asylum career, thirteen years ago, 
the institution accommodated in the neighborhood of 500 patients. Of 
these, it was at that time thought necessary to restrain upwards of a dozen 
or fifteen patients daily, and many of them nightly. Thus has reform in 
our attitude toward patients, and progress in their care, been displayed. 
With our 940 patients, there is now less noise and excitement, less gen- 
eral untidiness, vastly less irritability and disorder, and a much greater 
respect for life and property on the part of patients, than then existed, and 
the relations of attendant to patient are more friendly, and more like those 
of nurse and companion. Accidents are much fewer and damages far less 
extensive. Curtains, pictures, mantels, mantel ornaments, and bric-a-brac 
adorn all halls, without exception. Occasionally a patient in a disturbed 
hall will, in a moment of irritability or excitement, remove the ornaments 
from a mantel and throw them out of the window. Such instances are 
rare, however, and the public spirit among patients of respect for property 
leads them to co-operate with the attendants in protecting articles of fur- 
nishing from the onslaughts of the mischievous and malicious. 
In conclusion, I would say (if this conviction is not to be inferred from 
the foregoing), that I am a thorough believer in non-restraint as a princi- 
ple, and an earnest advocate of it at all times. 
Very truly yours, C. B. BURR, 
Medical Superintendent. 
Dr. Needham is a high authority among British alienists, 
and I quote from his report of 1888, at a time when this 
subject attracted so much attention in England. HON. JOHN L. HENRY, 
Associate Justice Supreme Court of Texas. HON. ALFRED REED, 
Supreme Court of New Jersey. 
HON. WM. J. MAGIE, 
Supreme Court of New Jersey. CARE AND TREATMENT OF THE INSANE. 
89 
Dr. Needham’s report of Barnwood Home contains his 
views regarding mechanical restraint. 
“No mechanical restraint has been used during the year, and seclusion 
has been resorted to very sparingly and only under exceptional circum- 
stances. 
“ With a sufficient staff of competent and experienced attendants I con- 
sider these abnormal expedients to be practically unnecessary, and their 
frequent adoption to point to remediable defects which in no institution 
for the insane should be suffered to exist. 
4 4 Both of them are allowable as means of medical treatment, under in- 
frequent and exceptional circumstances, and a superintendent would, I 
think, be unwise, who repudiated them altogether, because they are 
unpopular and, when abused, may lead to undesirable results. 
“ But he certainly would not be justified in their use from motives of 
economy or to obviate defects in the number or quantity of his attendants 
or nurses, or to save the trouble of resorting to more complicated, but less 
objectionable expedients. 
4 4 It may be said broadly that the modern practice of approximating 
asylums as closely as possibible in the furniture and decorations, and in 
the absence of special asylum features to ordinary dwellings, of removing 
unnecessary restrictions and extending personal liberty as widely as is 
compatible with safety and public comfort, has done much to render such 
methods of management rarely necessary.”—Journal Menial Science, 
Vol. 35, p. 243. 
Dr. Powell, the well-known superintendent, in his report 
for 1888 on the use of gloves as a means of restraint in 
Nottingham Borough Asylum (England), says: 
4 4 The gloves were used in the case of a man who night after night des- 
troyed every article of his clothing, bedding, etc. He continued to wear 
them for some time, but no sooner were they left off than he resumed his 
old habit, and, instead of restraining him again, I placed him to sleep in 
the observation dormitory, and instructed the attendant to prevent him 
from tearing his clothes. 
“The result has been, to a considerable extent, satisfactory. The ex- 
perience of this case has strengthened the view, which I held before, that 
where it is possible to keep patients from their mischievous habits by 
means of personal attention, it should be done by night as well as by day, 
because there is no doubt that to restrain mechanically has a degrading 
influence upon the patients, and also has a bad effect upon the attendants; 
it makes them less energetic and careful if they know that means other 
than their attention are readily applied to prevent patients doing mis- 
chief.”—Id., Vol. 35, p. 432. 
Dr. Tate, the well-known superintendent of the lunatic 
hospital at Nottingham, England, in his report for 1888, 
says: 90 
MECHANICAL RESTRAINT IN THE 
“ I have much pleasure in stating that another year has passed without 
either restraint or seclusion having been been found necessary. During 
my thirty years of superintendence I have endeavored to avoid the use of 
either, and with the exception of one instance of the latter, I have so far 
succeeded in doing so. I have been strongly tempted on several occa- 
sions to employ both, but by delaying the evil hour have been enabled to 
do without either. An occasion might, however, at any moment arise, 
when I should consider mechanical restraint of some sort not only neces- 
sary, but the wisest and most humane method of treatment.”—lb., Vol. 
35, P- 432. 
Dr. G. A. Tucker, is the author of “Lunacy in Many 
Lands,” and has visited more asylums for the insane than 
any other ten men in the world together. He has resided in 
Australia, but is now in London. He says: 
“ Mechanical restraint, according to Webster’s English Dictionary, 
“ Pertaining to, governed by, or in accordance with, mechanics, or the laws 
of motion ; depending upon mechanism or machinery.” 
I can understand superintendents of very large and perhaps overcrowded 
asylums, where individual attention to the patients by the superintendent 
becomes laborious or impossible, with perhaps an insufficient number of 
attendants, adopting restraint as a means of security and relief from 
anxiety. 
The same may apply to the superintendent who undertakes other duties 
than those appertaining to his office of medical superintendent, work that 
calls him away from his patients for a considerable portion of the day, and 
there are some whose time is greatly taken up with outside duties. 
My opinions on this subject are strongly expressed in my book, “ Lunacy 
in Many Lands,” which please refer to, 
“Pleasant surroundings, occupation, and adequate individual attention 
and treatment, are effective substitutes for restraint.” 
I found 219 asylums using restraint, and 118 asylums where no restraint 
is used. 
“ As a rule, where restraint is most used, it will be found that the 
management is the most defective.” 
b G. A. TUCKER. 
Dr. Yellowlees, wlio has been President of the British 
Medico Psychological Association, and perhaps the foremost 
of English alienists who seek to introduce mechanical re- 
straint in British Asylums, defends the system. His reply 
is as follows : CARE AND TREATMENT OF THE INSANE. 
91 
Royal Asylum, Gartnavel, Glasgow, Nov. 21, 1891. 
Clark Bell, Esq., Editor of the Medico-Legal Journal: 
Dear Sir:—I fully appreciate the compliment you pay 
me in desiring—through your letter to our mutual friend, 
Dr. Ireland—to know my views on non-restraint. 
I have already given them so fully in our Journal of 
Mental Science for January, July, and October, 1889, that 
you must please forgive me if I refer you to these writings. 
The first is the fullest, but I content myself with a short 
quotation from the latest. 
I also send you herewith the “ deliberate opinion ” of our 
Medico-Pychological Association on the subject. You will 
find it in paragraph 22 of the accompanying report, and we 
have few who differ from it. 
“ The question whether the use of restraint is ever beneficial, and there- 
fore right, in the treatment of the insane, might surely in these day6 be 
considered on its own merits, and apart from traditional authoritj' or per- 
sonal bias. There is no other question of medical treatment about which 
physicians may not legitimately differ, and agree to differ ; hut let anyone 
dare to think or act independently as regards this particular treatment, let 
him dare say that restraint prescribed by a humane and experienced phy- 
sician is totally different from the restraint inflicted by cruel or unen- 
lightened men in bygone days, and he at once encounters reproach and 
blame, as if non-restraint were a rule revealed from heaven, whose universal 
obligation and absolute wisdom it was little less than sacrilege to question. 
“Is not an asylum in its very nature a place of restraint as well as of 
treatment? Is not seclusion but a loose kind of personal restraint? Is it 
not interference with personal liberty to feed by the stomach-tube, and a 
yet greater interference to inject poisonous drugs into the tissues ? Yet all 
this may be right and proper and praiseworthy ; but if you dare under any 
conceivable circumstances to fasten the patient’s hands, or to swathe him 
in blankets, you have committed an outrage on humanity, and deserve the 
direst censure. 
“This reductio ad absurdum obviously needs some excuse, and when 
reason fail's them, the extremists fall back on sentiment. They pose be- 
fore the public as the special friends and protectors of the insane, declaim 
against backsliders, and prophesy the re-degradation of the insane and the 
return of all the horrors of the restraint ; all because some physicians, who 
are as humane and benevolent as themselves, and their equals in skill and 
experience, decline to accept the rule of absolute non-restraint, and believe 
that in certain rare and exceptional cases restraint may be the best and 
the kindest treatment. The excuse is bad, and the sentiment mistaken. 92 
MECHANICAL RESTRAINT IN THE 
The abuse of anything can never condemn its proper use, and the tacit 
assumption that the devotees of non-restraint are kinder, more humane, 
and more anxiously considerate of the welfare of the insane than their 
medical brethren is uncharitable and groundless.”—Dr. Yellowlees, quoted 
from Journal of Mental Science for October, 1889, p. 478. 
Yours very faithfully, 
D. YELLOWLEES. 
Dr. Yellowlees enclosed me a copy of a report of a select 
committee appointed by the British Medico-Psychological 
Association at the annual meeting of 1890 to formulate 
propositions as to the care and treatment of the insane, com- 
posed of Dr. Yellowlees, President, and Drs. Clouston, Ley, 
T. McDowall, Needham, Hayes, Newington, Rogers, Savage, 
Hack Tuke, Urquhart, Whitcombe, and Ernest White. The 
report contains thirty-two clauses or paragraphs of opinions, 
as formulated by that committee, the first nine of which are 
“ Regarding Insanity Generally,” the next eight (10 to 18), 
“ Regarding Patients in Asylums,” the next eight of which 
(18 to 25) are “ Regarding Special Classes of Patients,” and 
the last seven (No. 26 to 32, inclusive) are “ Regarding Ad- 
ministrative Staff, &c., of Asylums.” 
Paragraph 22 of this report, to which Dr. Yellowlees refers 
in his letter, is as follows: 
“ 22. In exceptional cases, seclusion and restraint are needful and bene- 
ficial. They should be used without hesitation, but only as a means of 
treatment, and by medical order, and their use should be recorded with 
punctilious care.” 
I take occasion to cite paragraph 21 from the same report, 
as germane to the discussion, though not quoted by Dr. 
Yellowlees, which is as follows : 
“21. Concerning dangerous and destructive cases, abundant exercise or 
occupation in the open air, an ample staff of attendants, attractive sur- 
roundings, and the wise use of baths and of calmative medicines, suffice for 
the care and treatment of many cases of this class, without any need for 
restraint or seclusion. 
“The admission into county or borough asylums of prisoners who have 
become insane is much deprecated, since their influence is subversive of 
morality and discipline.” CARE AND TREATMENT OF THE INSANE. 
93 
Preston Lodge, Prestonpass, East Lothian, 
Scotland, 9, 11, ’91. 
Dear Sir:—I have transmitted your letter, with the enclosures, to Dr. 
Yellowlees. In the Journal of Mental Sciences of January, 1889, p G21, 
you will find not only his opinion on mechanical treatment, but those of 
some other physicians experienced in the treatment of insanity. My own 
views are given on page 625. 
It seems to me that in some cases of extreme violence and restlessness 
mechanical restraint is more efficacious and less irritating than treatment 
exercised by the muscular resistance of attendants. 
It has been abused in times past, but not more so than muscular force 
has been. 
It has been well said that, in this country at least, the use of mechanical 
restraint is a measure of the conscientiousness of the Superintendent. A 
selfish, calculating superintendent would not use it at all. He would know 
that he wras in danger of censure for so doing, and would prefer throwing 
the burden and danger upon the attendants and the patient. 
From the debate reported, you will see that the superintendents at the 
meeting were unanimous in favor of mechanical restraint on some occa- 
sions, though they might differ as to the frequency of these occasions. 
Hoping this may find you well, I remain— 
Yours truly, 
W. W. IRELAND. 
To Clark Bell, Esq. 
The communication of Dr. Yellowlees brings to mind the 
exciting discussion in England regarding the subject of 
mechanical restraint as practiced at Bethlem Hospital. 
This had originally been conducted in the lay press, as we 
recollect it, by writers in the London Times and elsewhere, 
prominent among whom was the celebrated Dr. John C. 
Bucknill, who had attacked an apparent return to the use of 
mechanical restraint in that hospital. 
At the meeting of the British Medico-Psychological Associa- 
tion, Nov. 8, 1888, Dr. Clouston, the President, in the chair, 
in Edinburgh, Scotland, Dr. Yellowlees introduced the subject 
in an elaborate paper in defense of “ one of the ablest and 
best-known of our asylum physicians, who has been arraign- 
ed for the undue use of restraint, and arraigned by one of 
the best-known and most distinguished psychologists in the 
country, joint author of the largest and best-known of all the 94 
MECHANICAL RESTRAINT IN THE 
treatises on Psychological Medicine,” as stated by Dr. Yel- 
lowlees in his paper, alluding to Dr. Savage on the one hand 
and Dr. John C. Bucknill, on the other. 
Dr. Yellowlees has stated in his letter the summary of his 
views, but what he did say, as reported in the January 
number, 1889, of the Journal of Mental Science, pp. 621, et 
seq., was then understood and probably intended, more from 
a feeling of loyalty, and as a defense of Dr. Savage, than a 
justification for any retrograde step in British asylums as to 
the use of mechanical restraint in such ways as it was then 
employed in so large a number of American asylums. 
The language employed, however, was quite broad enough 
to encourage that large class of superintendents who resorted 
to mechanical restraints quite generally in their practice, and 
was a blow to the efforts of those who endeavored to elimi- 
nate acknowledged abuses,, by its total abolition, as a choice 
of the lesser of two evils. 
It was true that in England opprobrium attached to those 
known to use mechanical restraints, and Dr. Yellowlees re- 
marks were a decided protest against such a fact, when its 
use could, in his opinion, be justified in the rare and extreme 
cases, which he designated as— 
1. In cases where the suicidal impulse is intensely strong. 
2. In cases of extreme and exceptional violence. 
3. In extremely destructive cases. 
4. The helpless and incessantly restless patients. 
In the discussion that followed at that meeting there was 
no marked dissent, though many differed with Dr. Yellow- 
lees, and Drs. Ireland, Bobertson, Trumbull, Urquliart, 
Howden, Borie, Butherford, Watson, Johnstone, and the 
President, Dr. Clouston, participated. 
It was a peculiar situation, and the assault upon Dr. 
Savage had been so severe and serious that, considering his CARE AND TREATMENT OF THE INSANE. 
95 
relation to the Society and its journal, marked dissent would 
have been regarded as almost a personal assault upon him. 
Dr. Robertson voiced perhaps the correct sentiment in 
saying— 
“That he was sure Dr. Savage had not used restraint unduly. He 
thought it hard that the man who was doing something to cure his 
patients should be abused, etc., and on this account he held Dr. Savage 
deserved the sympathy of the Association.” 
There was not one member wTho spoke against the use of 
restraint, of those present, on principle, and the discussion 
was in such form that it would have been a substantial 
censure of Dr. Savage to have done so. 
The questions involved, were, however, higher than per- 
sonal considerations, or the mere opinions of men, no matter 
how prominent. 
The real issue was, underneath all, should English super- 
intendents abandon the ground almost universally held for 
the past half century and resume restraint in practice in the 
individual discretion of superintendents who believe it easier 
to resort to it than to dispense with it. 
The protest that attracted most notice was the vigorous 
one of the distinguished Dr. Alex Robertson, physician to 
the Royal Infirmary and City Parochial Asylum of Glasgow, 
Scotland, who published his views in the April number of 
the Journal of Mental Science, 1889. I give his letter as a 
part of the present discussion: 
To the Editors of the Journal of Mental Science: 
Gentlemen.—The Journal for January of the present year contains a re- 
port of an important discussion “ On the Use of Restraint in the Care of 
the Insane” at the Edinburgh meeting of the Association in last Novem- 
ber. As I wras unable to be present, I ask you to be so good as to permit 
me to express my views through the medium of your columns on this 
very important subject. I learn from the report that it has been the occa- 
sion of a controversy in the Times between leading members of the pro- 
fession in the south, but as I have not seen the articles on either side, 
my remarks can in no way be influenced by the opinions of any of the 
writers. 96 
MECHANICAL RESTRAINT. 
Many, like myself, will have learned with no small surprise that the use 
of mechanical personal restraint, to a somewhat considerable extent, is 
advocated by physicians in charge of leading asylums. Hitherto even in- 
telligent laymen, when they have had occasion to refer to the evidences 
of progress in the nineteenth century, have in illustration pointed with 
pride to the non-restraint system of treatment in our asylums for the in- 
sane. Distinguished Continental and American physicians have studied 
it in operation in these institutions, and recorded their high appreciation 
of the results. Its beneficent influence has also extended to many of the 
asylums of other lands. While I write, the biennial report of the Ala- 
bama Insane Hospital has just been received. Dr. Bryde, the physician- 
superintendent, in referring to “ the abolition of all mechanical restraint” 
some years ago, remarks: ‘‘Every year’s experience since that notable 
event has impressed me more and more forcibly of its supreme wisdom 
and efficacy; our wards are as quiet under this system as those of any 
well-ordered private family.” After many more remarks of a similar 
kind, he closes with a note of warning, “ Let us see to it that we take no 
step backward.” 
Many of us can still recall the gratification felt on the presentation of 
of the bust of Conolly by the late Baron Mundy, M. D., to the Associa- 
tion, and afterwards through its representatives to the Royal College of 
Physicians of London. That eminent physician, in his eulogy of Conolly 
on the occasion of its formal acceptance by the College, said, addressing 
the chair, ‘‘You have been enjoying for almost a quarter of a century the 
work of the great man who is no more, and still your neighbors, close to 
your shores, have yet, at the moment I address you, two thousand unfor- 
tunate beings tied in strait jackets . . . and the total number of in- 
sane on the Continent confined in cells, fastened in beds, and strapped up 
in strait jackets amounted in 1867 to fifty thousand. It is for me as a 
foreigner a humiliation, and perhaps at the same time a proof of my pro- 
fessional courage that I denounce these facts before so high an authority 
as yourself, and on so solemn an occasion as this of to-day.” The Presi- 
dent of the College, the late Sir Thomas Watson, in the course of his 
reply, remarked: “ His (Conolly’s) name will go down to a remote pos- 
terity, and be reckoned among those of the greatest and most noble bene- 
factors to a very suffering portion of the human race that our profession 
and our country have ever produced.” Little did either of these eminent 
men then think that within twenty years of the time they spoke, physi- 
cians of eminence at the head of some of our chief asylums would have 
advocated a return to the use of measures of restraint whose all but total 
abolition was the special glory of Tuke at York, and Conolly at Hanwell, 
and reflected honor on the land of their birth. 
[TO BE CONTINUED.] RETIRING ADDRESS.* 
BY CLARK BELL, ESQ., AS PRESIDENT OF THE MEDICO-LEGAL 
SOCIETY. 
To the Fellows of the Medico-Legal Society: 
It is twenty years last November (1891) that I was elected 
to the Presidency of this body, and it may not be uninterest- 
ing in the few words I shall say in introducing my successor, 
to give a retrospect of the progress of the Science of Legal 
Medicine in the intervening years, and touch on the influ- 
ence of the Medico-Legal Society upon the growth of public 
interest in its advancement during that period. 
I found the. Society then a small but earnest group of 
men, who had gathered around that center to awaken an 
interest in the professions of Law, Chemistry and Medicine, 
in the more careful study of the science of Medical Jurispru- 
dence, and to bring the professions of Law and Medicine, 
then standing aloof and at arms length from each other, into 
more intimate personal and social relations, and all these 
professions united in the the Council Board of a body formed 
to become earnest searchers after the truth. Of the early 
names that were gathered into this work, but few survive. 
Dr. Finnell, the first President, Dr. Stephen Bogers, who 
interested me and brought me into the body, have passed 
into eternal rest. Prof. Frank Hamilton, whom I nominated 
as my successor in 1875, after my first three years of service, 
and Dr. Charles S. Wood, who later succeeded as President, 
have also passed away. There still survive Hon. Jacob 
F. Miller, who followed Dr. Finnell as President of the So- 
♦Delivered January 13, 1892. 98 
RETIRING ADDRESS OF CLARK BELL, ESQ. 
ciety, Hon. Geo. H. Yeaman, who succeeded Dr. Hamil- 
tom, Prof. R. Ogden Doremus, and Dr. Isaac Lewis Peet, 
who have each served terms as President, but the major 
part of the time since 1871 I have led the students who have 
kept the fires burning upon the altar in this temple of science. 
Of the lustrous names that I brought into this Society, which 
we have survived, I shall mention only Dr. James R. Wood, 
the great surgeon, Hon. E. W. Stoughton, Edward Dickin- 
son, Aaron J. Yanderpool, Prof. Fordyce Barker, Dr. Geo. 
M. Beard, Judge John R. Brady, out of a list of hundreds of 
others who participated in our earlier labors. 
The library was founded during the first year of my ser- 
vice. The volumes of the earlier labors were published up 
to and including Volume Three in what are known as Medico- 
Legal Papers, and a large illustrated edition was also issued 
of Volume One. Volume Four is now more than half com- 
pleted, as is also Volume Five. 
The Medico-Legal Journal was founded in June, 1883, 
and from its small beginning is now completing its ninth 
volume—going to your members and subscribers in all 
lands. 
The movement to make the body national and even inter- 
national, although more recent, has been crowned with great 
success. Its active membership is now extended into nearly 
every State and Territory of the American Union, and into 
foreign provinces and countries; while its corresponding 
list of members embraces the greatest names of the profes- 
sions of Law and Medicine in all parts of the civilized 
globe. A Vice-President has been elected from nearly 
every American State and Territory, as well as from many 
of the leading foreign countries of the world. 
The ashes from this altar traversed the Atlantic and were 
kindled into a flame in Paris that blazed up into the Medico- 
Legal Society of France. RETIRING ADDRESS OF CLARK BELL, ESQ. 
99 
A similar movement is more recent in Italy, and the study 
of the science has been quickened and stimulated in every 
capital of Europe by the labors of this body. 
In America, similar societies devoted to the science have 
been founded in the cities of Chicago, of Philadelphia, of 
Denver, and in the States of Massachusetts, and of Rhode 
Island. 
We need not stop to recapitulate or measure the influence 
this body has brought to bear upon legislation in the Amer- 
ican States, nor upon the public sense, of the intimate rela- 
tion the science bears to the rights of the citizen in the 
administration of Justice, in the public tribunals, civil and 
criminal. 
No one can now measure it. The careful student of our 
century, who writes at the middle of the next, can better 
judge of the great work this body has accomplished during 
the past twenty years, than could any one now. From a 
small body of men we have grown to a Society which now 
numbers more than 1,000 names on its active, corresponding, 
and honorary lists. 
Not the least important of our labors have been those in 
connection with the International Medico-Legal Congress, 
held in this city in June, 1889, and which then perfected an 
organization, which has decided to hold a second session 
in 1893, as we hope, in Chicago, in which students of the 
science throughout the world are now enrolling themselves. 
These, in brief, have been our labors. And these open 
up the field of the future usefulness of this body. As I have 
been selected to preside over the International Congress of 
1893, and the labors of preparation for that event, in con- 
nection with editorial duties upon the Journal, I have been 
compelled to ask for assistance, or, rather, relief from the 
duties of your presiding officer. 
The Society is most fortunate in having for some years in 100 
RETIRING ADDRESS OF CLARK BELL, ESQ, 
its membership a member of the judiciary of a distant State, 
who has recently come to sojourn in this city. He has been 
selected, upon my nomination, to fill this chair. He is a 
stranger to many of you personally, but he is well equipped 
for the work you have entrusted to his hands. 
The increasing burdens of my professional life have com- 
pelled me to retire from a portion of the duties placed upon 
me in advancing Legal Medicine in the world, and I know 
of no safer hands in which to place the trust than those 
selected by the suffrages of your body. 
I have the honor, ladies and gentlemen, and I assure you 
it is a sincere and a great pleasure, to present, as my successor, 
Judge H. M. Somerville, late of the Supreme Bench of Ala- 
bama, as President elect for installation as President of the 
Medico-Legal Society of New York. MEDICAL JURISPRUDENCE, THE BAR, 
AND THE JUDICIARY.* 
BY CLARK BELL, ESQ., OF NEW YORK CITY, PRESIDENT INTER- 
NATIONAL CONGRESS OF MEDICAL JURISPRUDENCE. 
The true aim of the advocate, he who aspires to a high 
place in the profession, should be to master the law as a 
science, and to leave no door of her temple unopened beyond, 
from or through which knowledge in any department or 
branch could be derived. 
That student of the law whose aim is highest must needs 
study, from the foundations upward, rather than from prece- 
dents or recorded decisions, inward or downward. 
The fault of modern legal education is most conspicuous 
where it ignores the fundamental principles of a science con- 
ceded to be exact, but whose study must needs be complete, 
exhaustive, organic, and profound to him who would absorb 
it, because the neophite has neither time, inclination nor 
opportunity, in the present schools of law, to do more than 
classify its outlines, much less to master its principles ; and 
so the graduates of these schools can rarely have learned at 
graduation anything more than a superficial view of those 
elementary principles that form, make up, and underlie what 
the concentrated learning of the great jurists of all the 
world have defined to be the law as a science. 
The old school of the Bar, the men who were profoundly 
learned in principles, whose study of cases was frequently 
•Read before the New York State Bar Association, January 21, 1892, 
and the Medico-Legal Society, of New York, February 10, 1892. 102 
MEDICAL JURISPRUDENCE, 
to see whether, and how far, the judges had sustained or 
departed from the underlying and controlling principles of a 
case—these men taught the law to their students and devo- 
tees much as Justinian framed his institutes, or Blackstone 
wrote his celebrated commentaries. To the modern student 
of the law school these works are undecipherable without a 
thorough reading and knowledge of the civilization of the 
age and the environment of the men who produced each. 
I never place Blackstone’s commentaries in the hands of 
one of my students without first asking him to read, with 
care, the introductory chapter of Robertson’s History of 
Charles the Fifth, so that he may understand what feudal 
tenures were, and know of what Blackstone speaks regard- 
ing the social fabric of the times in which he wrote. The 
tendency, the whole trend, of legal study in our day seems, 
however, rather to have avoided considerations which con- 
trolled the abler jurists of the first part of this century, and 
our young men, varnished, furbished and brightened in cer- 
tain departments of the science, come into the profession 
from the schools with crude ideas of what a mastery of the law 
means, and so drift, almost of nesessity, into specialties, except 
a rare few, who are ambitious to attain higher excellence and 
cultivate more profound research, and who delve at the foun- 
dations for superior knowledge. 
We rarely meet with the young lawyer now who rightly 
regards the law school as a mere vestibule or passage way 
that leads up to the profounder study of the law; and it is 
only to such that we may look for that solid learning, great 
legal acquirements, and profound study which characterize 
and mark, as the rich rewards of application and high en- 
deavor, the paths trod by those great names, who are, by 
general consent and acclaim, named as the uncrowned kings 
of the legal profession. It is, perhaps, natural that in a 
scramble, or hurry and scurry race, over the heads or depart- HON. CHARLES GRANT GARRISON. 
Associate Justice Supreme Court of New Jersey. 
HON. GEORGE T. WERTS, 
Associate Justice Supreme Court of New Jersey. THE BAR, AND THE JUDICIARY. 
103 
ments of the science, that many students feel compelled to 
make, such only should be selected as seemed most promi- 
nent, and thus apparently the more valuable; and such ignored 
or excluded as were considered least desirable in practical 
results, like men in a burning dwelling seizing those articles 
easiest to reach and safest to remove. 
MEDICAL JURISPRUDENCE. 
This may have been the controlling reason, or one of the 
most important ones, why Forensic Medicine has not received 
that attention in the curriculum of legal study that its im- 
portance demanded, or that higher order of scientific research 
which its acquisition required. 
It is a rare thing now, in the American schools of law, to 
find a chair of Medical Jurisprudence in fact, or frequently 
even in name, and it is a scandal upon our law schools that 
they frequently graduate young men, and receive them into 
the profession, who have not studied this branch at all, or 
who have merely skimmed the surface of a few text-books, 
if they have ever entered even the head lines of leading sub- 
jects upon their note books. 
This is a great stain upon our law-school system, and low- 
ers our standard of legal education, and it should be at once 
rectified. 
If we are to regard the profession of the law as one of the 
learned professions, we should not be willing to consent that 
an institution should graduate a man, ignorant of the simplest 
principles of Medical Jurisprudence, any more than one who 
knew nothing of the laws of practice, or of the principles of 
commercial law. See what is in the immediate field of labor 
of the graduate who commences to practice the profession of 
the law in almost any sphere into which he may be thrown, 
even at the outset. 
1. The law regarding undue influence in respect to wills. 104 
MEDICAL JURISPRUDENCE, 
The law of testamentary capacity. The law relating to insan- 
ity as affecting civil responsibility in wills, deeds, or contracts 
and the whole domain of commercial law. 
2. The wide field of law regarding the insane, their care, 
treatment, and their civil rights as such. The question of 
responsibility of the insane in criminal cases and the ques- 
tions involved, extending into all the ramifications of our 
national life. 
3. The domain of State medicine, of life insurance, of mal- 
practice, and the whole work, scope and duty of the coro- 
ner’s office. 
4. The administration of Justice, with the work of the 
public prosecutor in a large line of criminal cases, requiring 
the same knowledge of Forensic Medicine in him who pros- 
ecutes as he who defends. 
5. The whole field of toxicological inquiry, with its close 
relation to the bench, the bar, and the administration of jus- 
tice. 
It has often seemed to me that the general ignorance of 
the profession, upon questions such as these, is something 
deplorable, and yet what a splendid field of study for the 
thoughtful and ambitious student is here opened, and how 
can any member of the bar deem himself worthy to enter the 
lists in forensic contests without preparation in that depart- 
ment of the law known as Medical Jurisprudence? 
It has been a refuge of necessity for the lawyer called sud- 
denly into a case demanding knowledge upon this intricate 
branch of the law to read up for the case at hand when the 
case presents itself. But where will he read? I remember 
when a boy, in my student life, standing by to see two 
country physicians conduct a surgical operation, where one 
held the book and read from it the instructions while the 
other cut. The blood flowed from the suffering patient 
while they discussed the true route of the knife, and our HON. ALEX. T. McGILL, 
Chancellor and Presiding Judge Court of Errors and Appeals 
of New Jersey. THE BAR, AND THE JUDICIARY. 
105 
case lawyers, in medical jurisprudence, present much such a 
spectacle and the client bleeds in much the same manner. 
THE BAE. 
Twenty years ago, when I was first called to the chair of 
the Medico-Legal Society of New York, (an organization 
formed and carried on to interest men of the two professions 
thrown in contact by questions of Forensic Medicine, to 
incite each to its more careful study, and to bring them into 
nearer and more intimate relations, socially and profession- 
ally, with each other,) there was no place where any collec- 
tion of works upon Medical Jurisprudence could be found 
worthy to be called even the nucleus of a library in that 
great city, the metropolis of the nation. 
There has been some progress made in those twenty years, 
not only in the city of New York, but in the State and the 
Nation, and the importance and claims of the science upon 
the bar, has advanced pari passu with the useful and per- 
sistent work of that body. 
The library of the Surgeon-General’s office at Washing- 
ton—thanks to the splendid energy of Dr. Billings—has 
grown within that period to be the best and most complete 
collection of works upon Medical Jurisprudence, not only 
upon our continent, but probably the whole world. 
Almost the first step taken by me when I came to that 
chair was to found a library of Medical Jurisprudence in 
New York, which is now second only to the one in Washing- 
ton, while all the law libraries have been inspired with 
greater zeal in increasing the value and importance of works 
in this department of legal science, and the lawyer of to-day 
suddenly called without preparation into this class of cases, 
all over the nation, can make easier answers to inquiries 
than he could ten, or even five, years ago. 
It is not a good thing for the active lawyer to defer his 106 
MEDICAL JURISPBUDENCE, 
study of the elementary principles of Medical Jurisprudence 
until his case arises, even if his office was in an alcove of 
the best library of Medical Jurisprudence in the land. 
It is a branch of the science requiring thoughtful, careful, 
and closer study than many others, and much as the fate of 
he who is forced by his training, environment, and educa- 
tion to be merely a “ case lawyer,” is to be deplored even 
in general practice; no where is his failures more likely to 
be fatal and more mortifying than in those cases, which, for 
the purposes of this address, I may designate as “ Medico- 
Legal Cases.” 
Take for example the lawyer who acts as District-Attorney, 
or his assistant, in the prosecution of criminal cases, in cases 
of homicide and lesser grades of offenses where these ques- 
tions arise. How illy fitted is any member of the bar for the 
discharge of the duties of such an office who has not studied 
Medical Jurisprudence thoroughly, as well upon its legal as 
on its medical side ? 
The advocate who is called to the defense of criminals in 
cases of homicide where the defense of insanity is interposed, 
in cases of poisoning, and in all that multitude of cases in- 
volving a knowledge of Medical Jurisprudence, is but ill 
equipped where the liberty, or even the life, of his client is 
in his hands, who has not mastered this department, and 
what are his chances of success against opponents learned in 
every branch and technical part of these questions? How 
is the lawyer competent to cross examine the medical or 
chemical expert, who in a crowded practice has to read 
books at night on the details of chemical questions and the 
field of mental medicine, matched against men who have 
mastered every detail of the science; and how immeasurably 
superior is the advocate for his work who has studied all the 
elementary principles before he took the case at all. 
The questions arising in Surrogates’ courts, and in a large THE BAR, AND THE JUDICIARY. 
107 
class of actions in the civil courts—in life insurance, mal- 
practice of physicians and surgeons, and analagous questions 
in the active practice of the busy lawyer, make it amazing 
that the student is not more thoroughly fitted for this portion 
of his duties by his preliminary education and training, and 
the fault is wholly that of the bar and our system, and not 
of the students of the law. 
THE JUDICIARY. 
But it is upon the bench that ignorance of the principles 
of this department of the law in its administration, and in the 
tribunals of justice, both civil and criminal, becomes, or is, 
most deplorable and reflects greatest discredit upon our sys- 
tem of legal education. 
It is a truism, and we need only state the proposition, that 
a judge who is to administer the law should be versed in its 
principles. 
That judge should be learned in all the learning of Medi- 
cal Jurisprudence who is the expounder of the principles 
under which offenses against the law are to be tried, investi- 
gated; and punished, and the importance of a proper ele- 
mentary education in Forensic Medicine in the judges who 
preside over the administrations of public justice is of the 
the highest consequence to the successful administration of 
our judicial system in the discharge of its great duty, to pun- 
ish real offenders, defend the innocent unjustly accused, and 
protect the rights and liberties of the citizen. 
I do not mean to say that a lawyer who has been elevated 
to the bench should decline the office because he never 
opened a volume that treated of Medical Jurisprudence, but 
he has before him the imperative and immediate duty of 
commencing de novo a study that should have been taught 
him as a student, with Blackstone and Kent, or as a part of 
that wider realm of the philosophy and ethics of the law, to 
enable him to be at all capable to sit in judgment upon 108 
MEDICAL JURISPRUDENCE, 
questions and principles of which he was ignorant when he 
donned the ermine. 
The American judiciary have presented, in the recent 
past, the most conspicuous examples of distinguished ability 
in grappling with the questions constantly presented to pub- 
lic notice in medico-legal cases requiring judicial interpre- 
tation. In the twenty years to which I have alluded there 
has been great judicial advance and evolution, and the light 
that has come from the bench has outshone and been more 
luminous than that from the bar. Take for example the ques- 
tion of the true test of responsibility in cases of homicides com- 
mitted by the insane. The absurd and false “Right and Wrong 
Test” that was given at the convocation of the English judges 
as the sequella of the McNaughton case, which has been made 
the rule in England for half a century. We took it in the 
American States, not by inheritance, but by force of habit, 
notwithstanding it was not a judicial opinion pronounced in 
a case pending in any court of law; not because it was the 
obiter dictum of one but of many judges on abstract proposi- 
tions; not because of any of the circumstances in English 
society life and conditions, which no doubt largely influenced 
the English judges to agree upon such a test, which, it is 
quite safe to say, had not before that ever been the law of 
England; but because it was easy and popular and fashion- 
able to accept a doctrine that our English cousins had 
agreed to accept, and so for nearly half a century this absurd 
doctrine has stood for the law in English speaking countries; 
and insane men by the score have gone to the scaffold in 
England and in American States, convicted by juries under 
this false and erronious test as charged by judges who fol- 
lowed this obiter dictum as if it were an authority. 
The emancipation of judicial thought from this error has 
been due almost wholly to the bench, and with almost a 
single exception to the American bench. THE BAR, AND THE JUDICIARY. 
109 
The man who more than all is entititled to the greatest 
credit for this bloodless revolution is Mr. Chief Justice Doe, 
of New Hampshire. 
His splendid opinion, which more than twenty years ago 
reversed the right and wrong test and commenced this eman- 
cipation of the American bench, placed New Hampshire in 
the vanguard of the American States on the right side of this 
question. I have space in this paper to name only three 
causes and but two or three of the men who have been most 
influential in this great judicial revolution. 
1. The medical profession from an ‘early day have en- 
dorsed the unanswerable logic of Chief Justice Doe’s opinion 
in the New Hampshire cases. 
2. An English judge (who, whatever may be said of his 
conduct in the celebrated poisoning case tried at Liverpool, 
which created such a sensation at home and abroad,) had at- 
tracted the attention of jurists throughout the world by his 
masterly statement of the falsity of the right and wrong 
theory as then accepted in England, in his remarkable and 
incomparable book upon the History of the Criminal' Law 
of England, a work which doubtless led (with his other 
writings) to his elevation to the English bench—this man 
more than any Englishman has played a most conspicuous 
part in this change of judicial ideas. 
Sir James Fitz James Stephen may have made mistakes in 
the Maybrick case, but the value and brilliancy of his life 
and writings upon this question should lead lawyers and 
judges to deal leniently with his errors, if such are claimed 
to have been committed on that trial. 
3. There is, perhaps, no more scholarly and splendid ar- 
gument among all the judicial utterances regarding this 
absurd doctrine than the opinion of the Supreme Court of 
Alabama, written by Judge Henderson M. Somerville, in the 
cases of Parsons vs. the State, which summarizes the pro- 110 
MEDICAL JURISPRUDENCE, 
gress and growth of this silent evolution of judicial opinion 
in the intervening years since Judge Doe laid his axe at the 
root of the tree destined to fall under the sturdy logic of his 
blows, and while these results have not yet been adopted or 
concurred in by the judges of all the American States, nor as 
yet by the English judiciary as a whole, the end has come of 
the “Eight and Wrong Test” in cases of insanity in Great 
Britian, and, I think, nearly so in America. 
In England the law officers of the crown now conduct an 
inquiry on their own motion in every case of doubt, with 
skilled experts of the first rank, like Dr. William Orange, se- 
lected by the prosecution, frequently before the trial, and it is 
quite safe to say that from this day onward no insane man 
will ever again be executed in England. 
In the recent case of Duncan, who was acquitted, Mr. 
Justice Lawrence charged the jury in England in the line of 
Mr. Justice Doe’s opinion, for Duncan well knew the differ- 
ence between right and wrong. He well knew the nature, 
character, and consequences of the act he committed, but 
these would not weigh if he was acting under an insane de- 
lusion which dominated his action and which he was power- 
less to resist or overcome. 
The end of the present century will beyond doubt see the 
end of this doctrine in criminal trials in every American 
State, and this is due almost wholly to the bench, and to the 
American bench. 
It is to the bench we must look for that growth, that evo- 
lution of the principles and application of the laAV to the 
corresponding growth in knowledge, and this applies to sci- 
ence, the arts, commerce, and all that marvelous development 
of our resources that marks out for the race which are to occupy 
the continent of North America for the next half century, a 
future best appreciated by Sir William Gladstone in his esti- 
mate of the growth and development of this continent, and its THE BAE, AND THE JUDICIARY. 
111 
population for only tire first half of the century on which we 
are so soon to enter. 
The progress of Medical Jurisprudence in this country in 
the last twenty years would, if correctly described, fill a paper 
much larger than the present one. During the past ten 
years it has been very great, and I may say that within five 
years last past it has been something prodigous. This is as 
true of Italy, France, Spain, Germany, and of continental 
Europe as of the American States. 
A new impulse has been given to the study of Medico - 
Legal Science, quickening and widening the labors of the 
students of law, and the approaching International Medico- 
Legal Congress of 1893, (which I hope will be held in 
Chicago), will doubtless add still greater luster and eclat to 
these studies, as did the work of the International Medico- 
Legal Congress of 1889, held in the city of New York, the 
influence of which has been felt throughout all the nations of 
the civilized globe. ' 
It is the duty of the bar association of this and every 
American State, and of the Nation, to co-operate with the 
resolution adopted at that congress, in hastening the day 
when every school of either law or medicine within the lim- 
its of the American Union should not only have a chair of 
Medical Jurisprudence, but require that the students of each 
profession should be able to pass an examination before 
graduation in this branch of science of such moment to the 
honor of both the professions of law and of medicine. THE PRESIDENCY OF THE MEDICO-LEGAE 
SOCIETY. 
To the Members of the Medico-Legal Society: 
Considerations of a personal and business nature compelled 
me to decline a re-election to the chair I have so long filled, 
with your kind suffrages. 
This step was taken in pursuance of a determination formed 
last year. 
The act does not signify any diminution of my interest in 
either the success of the Medico-Legal Society or in the 
progress of medical jurisprudence. 
The labors incident to perfecting the arrangements for the 
International Medico-Legal Congress of 1893 require a large 
portion of my time. 
The field occupied by the Medico-Legal Journal is broad- 
ening and widening, and constantly increases demands upon 
me, which I can with difficulty meet. 
I am in the active practice of the law in the city of New 
York, and the time has come when I need to lay down some 
of the labors devolving upon me in the Medico-Legal So- 
ciety, at least for the present. 
The gentleman who has consented to accept the high posi- 
tion is one every way competent to fill the place with dignity, 
ability, and credit to the body. Judge Somerville has lately 
resigned from the bench of the Supreme Court of Alabama 
to accept a position on the National Board of Customs Ap- 
praisers, to which place he has been, although a Democrat, 
appointed by the President of the United States. His tempo- 
rary residence will be in the city of New York, and I estem it a 
great piece of good fortune for the Society, as it is a sincere 
pleasure to me, to nominate him for the chair I have so long 
held by your kind indulgence and partiality. 
With sincere thanks to you all, who have so splendidly 
sustained me during my administration, and with earnest 
hope that the change may be for the welfare of the body 
and the progress of the cause, I remain, 
Very faithfully yours, 
CLABK BELL. 
New York, Nov., 1891. HON. HENRY C. PITNEY, 
Vice-Chancellor of New Jersey. MECHANICAL RESTRAINT IN THE CARE 
AND TREATMENT OF THE INSANE.* 
CLAKK BELL, ESQ. 
The report of the Edinburgh meeting certainly conveys the impression 
that the majority of the speakers approve of the use of restraint. But the 
practice of some of them scarcely bears out this theoretical expression of 
opinion. Thus Dr. Clouston applies restraint in surgical eases only, and 
where the suicidal disposition is exceptionally pronounced. Dr. Turn- 
bull’s practice is the same, but he distinctly states that he restricts the ap- 
pliance in the suicidal cases to night. The form I infer to be always 
“locked gloves.” Dr. Rorie only uses the “ gloves” in “extreme cases,” 
but he does not specify what these are. Now I have always understood 
that even Conolly fully allowed the use of mechanical restraint in surgical 
cases. I am inclined to think, too, that even though a medical superin- 
tendent orders a pair of locked gloves to the hands of a highly suicidal 
patient at night, the hands being otherwise free, in rare and extreme 
cases, but only in such cases, he may still be claimed among the support- 
ers of non-restraint. But whatever opinion is entertained on this point, 
there can be no doubt that the position of at least Drs. Yellowlees, Urqu- 
hart, and Johnson is very different. As the views expressed by Dr. 
Yellowlees were fully endorsed by the two other gentlemen, we turn to 
him for an exposition of his opinions. These were put very definitely be- 
fore the meeting, He thinks that the use of mechanical restraint is re- 
quired in four classes of cases. I quote his words: “ i. In cases where 
the suicidal impulse is intensely strofig. I have no hesitation whatever 
in putting gloves on these patients for their own safety and the protection 
of the attendants in charge of them. 2. In cases of extreme and excep- 
tional violence. I think the use of gloves often wise in such cases. Once 
or twice I have used side-arm dresses, although not for many years. 3. 
In extremely destructive cases. 4. The helpless and incessantly restless 
patients, who day and night roll about the room,” etc. For the last class 
he recommends the “protection bed.” This, as I saw it many years 
since in an American asylum, is a deep and narrow box-bed, with a spar- 
red lid or cover. The patient lies on a mattress in the bottom of it, and 
the lid, which is locked, prevents him from rising into the erect posture. 
It seems to me that a question of this kind can only be determined by 
results. Comparison should be made between asylums in which restraint 
is used to the extent advocated by Dr. Yellowlees and those where Con- 
oily’s principles are still in force—where there is a minimum of restraint. 
This can be best done by a candid statement of experience based on a 
long series of years. I shall do so myself, and at the same time invite Dr. 
Yellowlees or any other gentleman who may concur in his views to put 
his experience also on record. In order that the comparison may be as 
♦Continued from page 96. 114 
MECHANICAL RESTRAINT IN THE 
complete as possible, it seems ad visible that the facts should be elicited by 
answers to a series of questions, as follows: 
Q. What is the length of your experience ? 
A. Three years as assistant, upwards of thirty years as physician-super- 
intendent. 
Q. How many patients are in your asylum ? 
A. On an average for the first 25 years, 203 ; for the last five years 
asylum only licensed for 125 ; always full, often two or three beyond the 
complement. 
Q. What is the average number of admissions ? 
A. For 21 years, between 1863 and 1883, the average number of admis- 
sions annually was 79; from 1884 to 1888, inclusive, 46. Besides, during 
each of the last twelve years 34 patients were, on an average, admitted on 
what are known as “ certificates of emergency,” and accommodated for a 
period not exceeding three days, when they were removed to other 
asylums, the parochial asylum being full. These cases, being usually in 
the acute stage of their illness, add greatly to the responsibilities of the 
management. 
Q. What has been the average proportion of recoveries, calculated on 
the admissions, say for the last ten years ? 
A. 47.3 per cent. 
Q. Is every kind of case admitted ? 
A. Yes; there is no selection. 
Q. What was the weekly cost of maintenance in your asylum during 
the last financial year ? 
A. 8s. -)4d. This includes repairs and charge for rent. 
Q. What is the proportion of day-attendants to patients in your asylum ? 
A. One to 15.8 patients. 
Q. What is your practice in the use of mechanical personal restraint ? 
A. No strait jacket, or “side dresses,” or anything of that kind has 
ever been used in my whole experience. Two patients suffering from 
surgical diseases, one 29 and the other 4 years since, were fixed to their 
beds by sheets and bandages till these ailments were cured, In a surgical 
case, at present, one glove is in use. In a small number of highly 
suicidal cases I have ordered locked canvas gloves at night, the hands 
being otherwise free. How rarely they are prescribed will be seen from 
the following list for the three years ending 31st December, 1888, which 
has been prepared from the statements of the attendants, corroborated by 
my own recollection, as no record was made; April, 1886, gloves one 
night; May, 1887, gloves one night; May, 1888, gloves two nights. Two 
were cases of attempted suicide, the third was strongly disposed to suicide. 
Q. What is your practice in respect of seclusion ? 
A. 'It is seldom used. Five patients were secluded during 1888, the 
sum of all their seclusions being 31 hours. No one was secluded in 1887. 
Q. Do you use guards of any kind for the windows or fires ? 
A. The only guards in use are two nursery ones, quite open at the top, 
and simply hooked on at the sides. One is over the fire in a parlor where 
there are many epileptics, the other in the parlor for the most violent 
cases. There is no guard of any kind over any of the windows. The CAltE AND TREATMENT OF THE INSANE. 
115 
windows are, of course, so fixed on the upper floors that they cannot be 
opened at the top or bottom above four inches. 
Q. How many, if any, homicides have occurred in your experience ? 
A. None. 
Q. How many, if any, suicides have occurred in your experience ? 
A. None. 
Q. How many important injuries to patients have occurred in the 
course of your experience, in struggles either with attendants or fellow- 
patients ? 
A. In ten cases bones were broken, but all were simple fractures. No 
patient is known to have suffered permanent injury. 
Q. How many, if any, attendants have been injured in your experi- 
ence? 
A. Two attendants have each had his shoulder dislocated, but it was 
easily reduced. These, and one or two temporarily stunning blows on 
the head, were by far the most serious occurrences. No one was ever 
permanently injured. 
Q. What was the value of the clothing of all kinds destroyed in your 
asylum last year ? 
A. 7s. 6d. 
Q. What was the value of the glass destroyed in your asylum last year ? 
A. Not more than is. 
Q. What have been the usual entries of the Commissioners in their re- 
ports respecting the order and quietude of your asylum ? 
A. Both have been stated to be satisfactory. There is, of course, 
occasionally some noise and excitement in the department for the acute 
cases. 
These details have been obtained by careful examination of the books 
of the establishment in the haads of Mr. Laing, the Governor of the 
Asylum and Poorhouse, to whom I am indebted for the trouble he has 
taken in this inquiry, as well as for his co-operation in the management, 
especially during late years. The results I believe to be creditable to the 
principle of non-restraint. I was trained in its practice by my late re- 
spected master and friend, Dr. Alex. Macintosh, of Gartnavel Asylum, and 
I have not yet seen any reason to modify my high appreciation of its 
wisdom and value. However, we must wait till those who favor the more 
extended use of restraint tell us their results before determining the ques- 
tion. Meanwhile, any who are in doubt may refrain from arriving at a 
conclusion. 
I may be asked: What are your methods of treatment ? I answer: 
“ Nothing special, simply careful individualization—studying and apply- 
ing the indications of management and treatment in each case—work, 
outdoor exercise, careful dieting, amusements, and medicinal treatment.” 
In reference to the last of these, I refuse to admit that when a patient is 
soothed by medicines fitted to allay the irritability of a brain in a state of 
disease, I am employing “ chemical restraint,” at least in the offensive 
sense attached to the expression by some, and especially by those who 
favor mechanical restraint. 
I have only further to express my regret that in this communication I 116 
MECHANICAL KESTKAINT IN THE 
have been obliged to name gentlemen whom I count among my personal 
friends. But all personal considerations must be sunk in view of the im- 
portance of the question under consideration. Especially do I regret that 
I have been constrained to refer particularly to Dr. Yellowlees. It is 
simply because he initiated and took by far the most important part in 
the discussion at Edinburgh, and is at present the leader in Scotland of 
what I believe to be a distinctly retrograde movement. He would do 
well to remember when advocating the cause of restraint or about to 
order the application of the “ side-arm dresses ” or the use of the “ pro- 
tection bed,” that there is a plate on the foundation-stone of Gartnavel 
Asylum bearing an inscription which declares that the asylum is erected 
on the principle of “ Employing no Mechanical Personal Restraint 
in the Treatment oe the Patients.” 
For tlie present this will give an introduction to the Eng- 
lish discussion of 1888, to which we may again refer. But 
meanwhile it might be well to see what the practice and 
sentiment has been in English asylums, where the discus- 
sion arose, to which I shall cite a few leading British super- 
intendents. 
Dr. Campbell, superintendent of the insane hospital for 
Cumberland and Westmoreland, in his report for 1888, pub- 
lished in the July number of the Journal of Mental Science, 
p. 248, states: 
‘ ‘ That during the year he had two such exceptional patients; that he 
had to seclude one, a patient who was so powerful and violent for several 
periods, and the other a feeble melancholiac, who made such persistent 
and varied attempts to kill himself that he used mechanical restraint for a 
long period, and who even then bit off his lower lip as far as he could 
reach it with his teeth.” 
Dr. Campbell says of the latter: 
“ This is only the second patient whom I have had to restrain for other 
than surgical reasons during the past fifteen years." 
Tlie experience of Dr. Howden, of the insane asylum at 
Montrose, who has had a very large and varied experience, 
as reported by him and cited in the October Journal of 
Mental Science, 1889, p. 429, is of great value in such a dis- 
cussion as the present. 
Dr. Howden says: 
‘‘It is better, I believe, as a rule, to treat excitement by good hygienic 
conditions, good food, unpolluted air, suitable clothing, abundant exer- CARE AND TREATMENT OF THE INSANE. 
117 
cise, and even hard work, combined with mental occupation and distract- 
ion, than to attempt to repress or conserve energy, whether by mechani- 
cal or therapeutic restraint. 
“A day’s labor, whether on the farm, in the washing house, or scam- 
pering on the grass, is a better hypnotic than any narcotic drug with 
which I am acquainted. 
“While expressing this opinion, I am far from ignoring the value of 
narcotics and of the necessity of employing mechanical restraint in cer- 
tain cases. ***** 
“While maintaining perfect freedom of action, however, unaffected 
alike by fashion and public prejudice, we must not forget the errors into 
which our forefathers fell, through prejudice and superstition, though 
they were probably actuated by motives as humane as we are, nor lose 
sight of the great principle of non-restraint, (falsely so called,) established 
by Pinel, Tuke, Hill, Conolly, and others, which has revolutionized the 
treatment of the insane, so that the modern asylum has the character and 
aims of a hospital and a sanitarium, rather than a prison or a poor-house.” 
Dr. Howden adds, referring to tlie criticisms made in the 
public press regarding the alleged improper use of restraints 
in Bethlehem Hospital the year before, and the defense of 
the system by Dr. Yellowlees before the British Medico-Psy- 
cliological Association, which is quoted by Dr. Yellowlees in 
reply, the following: 
“ In view of the discussion which took place last year in medical cir- 
cles and in the public press on the use of mechanical restraint in the 
treatment of the insane, it may not be amiss to place on record a sum- 
mary of my own practice during a period of thirty years, as a contribution 
to the subject. In doing so I shall consider seclusion as well as mechani- 
cal restraint, ist, because they are often employed vicariously aud con- 
jointly, and, 2d, because I consider that seclusion in a dark room during 
the day is often a much more objectionable form of restraint than the use 
of mechanical means for restraining merely the muscles and the hands. 
“Well, during the past thirty years 4060 cases have been under treat- 
ment. Of these, 29 men and 26 women have been subjected to the res- 
traint of the strait jacket. 
“The reason for employing mechanical restraint with these 55 persons 
was, in five cases, to prevent injury to the patient or others during attacks 
of exceptionally violent mania; in nine cases, to prevent self-mutilation 
and suicide; while, in the remaining forty-one, it was used to prevent the 
removal by the patient of dressings in surgical treatment. ’ ’ 
Dr. Howden also adds, regarding the use of locked gloves 
under the Scotch system of “ Register of Restraint and Se- 
clusion to prevent babies from sucking their thumbs and 118 
MECHANICAL RESTRAINT IN THE 
patients from pulling out tlieir hair or picking their faces 
or head with their nails, that, searching, he finds— 
“ In the old daily register, however, there was, and I find entries of, the 
employment of locked gloves in the cases of three men and one woman, 
for a total period for the four of 150 hours, during 20 years. ’ ’ 
As to seclusion, the doctor makes the following statement, 
and these reports are of great importance to show the al- 
most entire abolition of mechanical restraint, and seclusion 
as well, which places the question of its abuse wholly out of 
question: 
“As to seclusion, I find that the number of persons who have been 
locked into a single bed room during the day in thirty years, was in 
all 106, of whom 38 were men and 68 women. During the first 
decennial period, from 1859 to 1869, there were under treatment 1740; 
of whom six were restrained, and ninety-one secluded. During the 
second decennial period, from 1869 to 1879, there were under treatment, 
1526; of whom seventeen were under restraint, and seven were secluded. 
During the third decennial period, from 1879 to 1889, there were under 
treatment 1633; of whom thirty-two were restrained, and eight were se- 
cluded.” 
Dr. Theodore Diller was entitled to reply to the discus- 
sion of his paper the evening it was read, and did so orally. 
At my request he submitted a revise of his remarks, which is 
as follows: 
Me. President : 
Let me attempt to analyze and classify the expressions of opinion 
which we have heard. 
I think all who have spoken are agreed upon certain point's, viz : That if 
mechanical restraint is ever applied, it ought to be used only by medical 
men ; that it must never be applied to punish patients, to keep them quiet, 
or to save trouble for officers or attendants. 
The various differences of opinion might be classified under three heads, 
as exemplified in the practice and views of Drs. Bryce, Pilgrim, and 
Godding, each of whom has a large number of patients under his care. 
1. Dr. Bryce has not restrained a single patient for many years. He ad- 
mits that cases may occur where restraint would be for the highest good of 
the patients, but he would not restrain such patients principally or wholly 
because lie holds that the possible benefits which might accrue to those so 
restrained would be more than counterbalanced by certain baneful effects or 
impressions produced upon themselves or upon other patients by the res- 
traint. 
2. Dr. Pilgrim has not restrained a single patient for a long time, but 
admits that cases might arise where this measure would be advisable, and 
would not hesitate to apply restraint in such cases. CAKE AND TREATMENT OF THE INSANE. 
119 
3. Dr. Godding lays stress upon the doctrine, taught by Butler, that an 
insane person requires individual treatment, just as an individual sick from 
any other disease. In carrying out this idea, he believes that he has served 
the best interests of certain of his patients by mechanically restraining 
them in a proper apparatus at certain times. 
The burden of my argument will be an endeavor to show that, of these 
three views and methods of practice that of Dr. Godding is the correct one. 
Between the views of Dr. Bryce and those of Dr. Pilgrim, neither of 
whom restrains patients, there is a great and vital difference. Both these 
gentlemen admit that patients might be placed under their care whose in- 
terests would be better served if they were mechanically restrained than if 
they were not so restrained. Dr. Bryce would not, but Dr. Pilgrim would 
restrain such patients, the former giving as the reason for his views that the 
few ought to suffer for the good of the many. 
There is also a difference between the views and practice of Dr. Pilgrim 
and those of Dr. Godding. The first-named gentleman, as a matter of 
practice, has not used restraint; the last-named gentleman applies mechan- 
ical restraint to certain of his patients. Each of these gentlemen believes 
he is best serving the interests of each and of all his patients with regard 
to his course of procedure in this matter of mechanical restraint. 
From this review I think it must be apparent to all that, although Dr. 
Pilgrim’s practice is substantially in accord with that of Dr. Bryce, yet 
there is far more harmony in views as to the principles involved, between 
Dr. Pilgrim, who does not restrain, and Dr. Godding, who does restrain, 
than there is between Dr. Pilgrim and Dr. Bryce. 
I am glad that Dr. Bryce has expressed himself so clearly. Certainly we 
know just where he stands. His views, I am glad to find, are shared by 
no one who has been heard to-night. I must say that I regard these views 
not only as extreme, but as containing in them great possibilities of danger; 
and I cannot help feeling that Dr. Bryce is moved to hold them 
largely for sentimental reasons. Evidently he takes a great pride in the 
showing his asylum has made in the past ten years. Even if an extraordi- 
nary number of difficult and trying cases were to be brought to him for 
treatment he would still carry out his non-restraint policy. Why ? Be- 
cause, I fear, “ non-restraint” has become a watch-word or a dogma with 
him ; because he would not care to have a blot on his unbroken record of 
“absolute non-restraint.” 
There is in London (and, if I mistake not, in Chicago also,) a so-called 
“temperance hospital,” which was founded and is maintained by those 
who believe that alcohol should never be used as a therapeutic agent; that 
its use is always wrong ; that it is an evil per se ; that it should never be 
given to any person, sick or well. In short, they contend that any disease 
is better treated without than with alcohol. This hospital is, I believe, well 
conducted generally. Its annual report makes a seemingly excellent show- 
ing, yet, withont knowing anything as to the details of its workings, I 
make bold to opine that certain of the patients treated within its walls 
would have been better treated had they received appropriate amounts of 
alcohol. It seems to me that this boycotting of a certain means of treat- 
ment by this temperance hospital which is sanctioned by the over-whelm- 120 
MECHANICAL RESTRAINT IN THE 
ing sanction of the medical profession, is quite analagous to Dr. Bryce’s 
boycott of another measure of treatment in the hospital of which he has 
charge. In each of these hospitals a certain means of treatment which is 
sanctioned by an overwhelming consensus of opinion of the profession is 
proscribed, largely or wholly for sentimental reasons. 
Aside from Dr. Bryce’s views, the expressions of opinion which we have 
heard seem to me to be pretty evenly divided between those who share Dr. 
Pilgrim’s views and those who share Dr. Godding’s views. This difference 
I believe is not irreconcilable—for it is a difference of measure or amount 
only, and not of kind or principle. I am quite willing to subscribe to Dr. 
Ciiapin’s view that it should be the endeavor of all physicians who have 
charge of insane patients to constantly endeavor to use less and less res- 
traint, but never to accept “non-restraint” as a dogma. 
It has often been said that restraint is a dangerous thing ; that it 
is too powerful and dangerous a measure to be placed even in the 
hands of asylum superintendents—much less in the hands of assist- 
ant physicians, supervisors, or attendants; that there is constant danger 
of its over-use, i. e., abuse; that in spite of all that can be done 
to prevent, attendants will fall into the way of using it without orders 
from physicians; that restrained patients exert a pernicious moral in- 
fluence upon other patients about them; that a restrained patient feels a 
terrible sense of degradation; that almost always other measures of treat- 
ment are better or at least just as good. 
The asylum superintendent has power over his patients, down to the 
smallest details of their lives. He must necessarily come in comflict with 
their wishes or inclinations many times and in many respects. lie must, 
at times, refuse one patient his jewelry; another, his shoes; another, linen 
table cloths and china plates: another, he keeps in-doors; another, he holds 
firmly on a mattress and forcibly injects poisonous drugs into his tissues or 
pumps fluid nourishment into his stomach against the patient’s earnest pro- 
test; he may cause another to be bathed against his will or secluded in a 
room. Any or all of the above measures may be used by the superintend- 
ent or assistant physicians. They are all measures of restraint, if you 
please. Certainly they may be called means of treatment (or therapeutic 
measures). No one gainsays the propriety of their use in appropriate cases. 
But, mark you, one other measure of restraint, one other means of treat- 
ment—mechanical restraint—is wrong per se; it is such a dangerous thing 
in itself that it cannot be trusted in the hands of the superintendent, w ho 
presumably is strong enough and wise enough and humane enough to 
rightly use all these other measures of restraint or means of treatment I 
have mentioned and many others. Surely this is a reductio ad absurdum. 
The correct position seems to me to be this: That mechanical restraint 
is a measure of treatment, a remedy of peculiar value —one which, in cer- 
tain cases, cannot be supplanted by any other from which an equally good 
result can be obtained. It is a dangerous remedy; the appliances for ad- 
ministering it should be locked up as safely as the hyoscine or chloral, and 
no one, other than the physician, should administer it any more than he 
should these other two dangerous remedies. Like all other powerful 
remedies, such as morphia, chloral, and alcohol, restraint has been too CARE AND TREATMENT OF THE INSANE. 
121 
much used and abused by some physicians. The abuse of opium in 
physicians’ hands has wrought far greater harm than has the abuse of 
mechanical restraint. Yet, in spite of this fact, the use of opium should 
not fall into complete desuetude—no more should mechanical restraint. 
In treating his patient, a physician who has charge of the insane ought 
to use therapeutic measures as a skilled mechanic uses special tools—use 
the right remedies for any given disease and be ever ready to withdraw 
any measures and add others, as may be called for by the varying manifes- 
tations of the disease. At one time it will be a duck dress; at another, 
1-100 grain of liyoscene; at another, seclusion; at another, piano-music or 
dramatic entertainment; at another, restraint; at another, open-air walks; at 
another, farm work. What would be thought of the carpenter who had a 
confessedly useful and effective tool and yet would not trust himself to 
use it? Yet this is the position of those who hold to “absolute non-res- 
traint ” as a dogma. 
It has been said that the presence of a restrained patient has a baneful 
effect upon the other patients about him. It must be admitted that there 
is some truth in this statement. Yet, after all, there is no very great force 
to this objection, for a restrained patient would, of course, not be in the 
same ward with mild patients or convalescents, but would naturally be 
placed in a ward containing the violent or the chronic insane by whom the 
niceties are little or not at all appreciated; and in these wards other sights 
may be witnessed (epileptic fits, e. g.), which would have quite as much or 
more deleterious effect upon the patients in the ward than the sight of a 
restrained patient. 
Now, as to the sense of degradation which restrained patients themselves 
experience. In some patients (e. g. dements), this feeling is nil. In 
others, where the feeling is experienced, likely the patients do not rebel 
against restraint as a personal indignity nearly so much as being compelled 
to receive forced feedings or hypodermic injections. 
Very often, perhaps generally, it is better to seclude a patient than to 
restrain him. But in some cases seclusion cannot be used in lieu of res- 
traint, if the best interests of the patient would be served. will mention 
a few illustrative hypothetical cases. A chronic maniac suffers from a 
fracture of the humerus, and will not permit the surgical dressing to re- 
main on his arm. A paranoic, under delusive promptings, makes persist- 
ent efforts to pull out his rectum or castrate himself; an epileptic, while 
in the post-epileptic state constantly picks his arms, producing horrible raw 
surfaces; a violently suicidal patient makes not only persistent attempts to 
take his life, but also constantly tries to injure or mutilate himself; a patient 
suffering from acute delirious mania (typhomania), would use up his little re- 
maining strength, all of which is precious to him, in order to carry him 
through the crisis, by unceasing muscular activity. In such cases as these 
I think Drs. Meredith, Chapin, Hill, Trowbridge, or Godding would use 
mechanical restraint. In such cases I, myself, have used it. 
One matter more, and I have done. Dr. Blumer (the successor of the 
honored Gray, of Utica, who used restraint as needed), says that he does 
not restrain patients, and immediately adds, with almost a “therefore,” 
that this is a closed question; that my letter is simply useless verbiage; 122 
MECHANICAL RESTRAINT IN THE 
that what I have said has been said very, very often. These are indeed 
strange views, especially coming from the source whence they do. I think 
Dr. Blumer’s views will find no responsive echo among the members of the 
Medico-Legal Society, composed of men and women who recognize the 
great principal that no question is a closed question upon which men 
honestly differ. I am quite as well aware as Dr. Blumer that the question 
has been many, many times discussed. I also know—perhaps letter than 
he—that it will be many times yet discussed before it will, in truth, be- 
come a “ closed question.” If I am not endowed with but little eloquence 
as compared with Dr. Blumer, I feel sure that my honest attempt to express 
my opinion upon this subject will at least be respected, while Dr. Blumer’s 
attempt to dispose of me and of my views with a sneer will be held in just 
and merited contempt, and, I trust, their author charitably pitied. This 
would be true, even if I were in a hopeless minority. But it is all the 
more true when you consider the large number and the great eminence of 
the men who hold the views for which I have contended in this discussion. 
These views, it was found, were held by nearly every man who attended 
the large meeting of British alienists held in Edinburgh so recently as 
1899. The men whose views are essentially the same as my own are too 
numerous to mention, nor could I call to mind a tenth of them just at this 
time. But among them are the great Yellowlees, Savage, Godding, Trow- 
bridge, Chapin, Meredith, Hughes, Prince, Curwen, Hill, Talcott, Lyon, 
Parker, Moncure, and Dewey. 
In closing I wish to thank Mr. Clark Bell for opening this discussion on 
so broad a scale, and to express my firm belief that distinct good will come 
from it. It will be better known hereafter than it ever was before, that 
the overwhelming consensus of opinion of alienists in the United States is 
that inflexible adhesion to the rule of absolute non-restraint as a dogma is a 
short-sighted, illogical, and unscientific policy—one which ought not and 
cannot be maintained. 
Dr. Alex. Robertson, M. D., F. F. P. P. and S., physician 
to the Royal Infirmary and City Parochial Asylum at Glas- 
gow, to whom I lately wrote for his views upon the subject, 
but who had not seen the prior discussion, responded as 
follows:. 
I have pleasure in complying with your invitation to express my views 
on the use of mechanical restraint in the treatment of the insane. You 
mention that there has been a correspondence on the subject in the Medioo- 
Lkgal Journal, and that you had posted a copy of the Journal containing 
it to my address. I regret, however, that it has not come to hand, and I 
therefore write without knowledge of what has been stated by those gentle- 
men who have already taken part in the discussion. 
I more willingly accede to your wish from the fact that in the year 18f»8 
I visited a large number of asylums in the United States and Canada, and 
then became acquainted both with their merits and demerits. The “ notes ” 
of my observations were published in the English Journal of Mental Icum «.Fhotn. tyHill.Ellzi;eth.N.J. 
ROBERT STOCKTON GREEN. 
Governor or new Jersey CARE AND TREATMENT OF THE INSANE. 
123 
Science for April, 1869, and I added to them as an appendix a short 
abstract of the late Dr. Willard’s report on the condition of the insane poor 
in the workhouses of the State of New York. At that time their care and 
treatment in all respects, in most cases, were very bad in these establish- 
ments. Since my visit of that year I know that great improvements have 
been made in the provisions for that unfortunate section of the community, 
both by the transference of many of them to new and well appointed 
asylums, and also by the adoption of more kindly and humane methods of 
treatment. 
Among the reforms which have brought the asylums of America to the 
front rank of such institutions throughout the world—at least in my 
opinion—is the almost complete disuse in many of them of the instruments 
of restraint. However, I gather from your letter that in some they are still 
largely used, and that those medical superintendents who employ them 
fortify their position by quoting the opinions recorded in favor of restraint 
by certain British physicians, notably Dr. Savage in England and Dr. Yel- 
lowlees in Scotland. 
It was with a mixed feeling of surprise and regret that about three years 
ago I learned that these gentlemen, physicians in the land of Tuke and 
Connolly, advocated so retrograde a measure and carried it out in their 
practice. Their action has, I believe, been prejudicial to the best interests 
of the insane in this country, and, as they might have anticipated, has so 
far, but I trust only temporarily, checked the movement for the further 
amelioration of their condition in the New World. 
My own acquaintance with the fact that mechanical restraint was some- 
what freely used in some of the asylums of this country was derived from a 
report of a meeting of Scotch asylum Superintendents in November 1888, 
which was published in the Journal of Mental Science. Dr. Yellowlees, of 
the Glasgow Royal Asylum, took the leading part in the discussion and 
spoke strongly in favor of the use of mechanical restraint, defining four 
classes of patients to whom he considered its application was proper and 
legitimate. Though there was a general theoretical concurrence in these 
views by other speakers, I was glad to find that some of the more ex- 
perienced in their practice really exceeded only by a very little the sanc- 
tion of Connolly, the gieat apostle of the non-restraint system. Thus Dr. 
Clouston, who has charge of the most important of our Scotch Asylums, 
stated that he used restraint only in surgical cases and where the suicidal 
disposition is exceptionally pronounced. I was not present at the meeting, 
hut on perusing the report of it I felt that the practice commended by Dr. 
Yellowlees more especially, was so opposed to my own, and was so calcu- 
lated to affect injuriously the treatment of the insane that it was incum- 
bent on me to record the result of my long experience and the conclusions 
at which I had arrived. Accordingly I drew out a statement in detail, 
which was published in the Journal of Mental Science for April, 1889. 
In the exposition of my position on the question I cannot do better than 
give a short r£sum£ of that paper. It appeared to me that in estimating 
the value of mechanical restraint the most exact and convincing test was 
that of results. Therefore, in the form of question and answer, I submitted 
all my experience as physician-superintendent of an asylum extending over 124 
MECHANICAL RESTRAINT IN THE 
a period of thirty years, which in any way bore on the subject, without 
any reserve. An idea of the method pursued will be formed from the fol- 
lowing quotations: (The letter of Dr. Robertson contains the questions 
and answers contained in the paper published in the Journal of Mental 
Science, which is published heretofore by me.) 
In this way in addition to these points, I showed the following as the 
results of my whole whole experience: 
1. Though there are no guards of any kind for the windows or fires, ex- 
cept two nursery ones open at the top and simply hooked on, the value of the 
glass destroyed during the whole of “ last year” (1888) was only one shil- 
ling, and of clothing of all kinds seven shillings and six pence. 
2. The proportion of recoveries calculated on the admissions for the last 
ten years was 47.8 per cent. 
3 The proportion of attendants to patients was one to 15.8. (This is 
less than in asylums where restraint is somewhat freely used.) 
4. That ten patients had suffered from broken bones, but all were simple 
fractures. No patient sustained permanent injury. 
5. There has never been either suicide or homicide. (This still holds true, 
2d April, 1892.) 
6. That no attendant has been permanently injured. Though two have 
sustained dislocation of the shoulder, it was easily reduced. These and one 
or two temporarily stunning blows on the head were by far the most 
serious occurrences. 
It will be evident that I cannot claim to have absolutely abolished me- 
chanical restraint in my practice. Still the fact that it was used only in 
the form of locked and padded canvas gloves in a few intensely suicidal 
cases, and that several years sometimes passed without their being once ap- 
plied, shows a near approach to complete non-restraint. 
After detailing my experience as above explained, I invited any of the 
advocates of the freer use of restraint to record theirs in the same way. 
No one, however, up to the present time, lias chosen to do so. Dr. Yellow- 
lees certainly stated that for a number of years there had been no suicide in 
the asylum of which he has charge. But this had reference only to one of 
the many points referred to in my record, and even in regard to it his 
statement was restricted to a part of his experience. It seems a legitimate 
conclusion that on all other points, as well as on the remaining part of his 
experience in the one he adduced, he felt his position to be a weak one; in 
fact that, with the free use of restraint which he recommends, he was un- 
able to submit so favorable statistics as 1 have done with all but complete 
non-restraint. 
Possibly some of my American confreres who favor restraint may ac- 
cept my friendly challenge. Should any one submit a better record than I 
have published, those who, like myself, adhere, or rather all but adhere, to 
the methods of Tuke and Connolly, may then reconsider their position. 
Meanwhile, even our opponents on this question must be constrained to ad- 
mit that if the results of non-restraint are only equal to those of restraint 
the palm rests with the former. A foi-tiori if it is clear that the results on 
all points are much more satisfactory, then surely there is strong argument 
against the harsh and forbidding methods of restraint. CARE AND TREATMENT OF THE INSANE. 
125 
In June, 1883, Dr. Alice Bennett, then, as now, medical 
superintendent of the State hospital for the insane at Norris- 
town, Pa., was requested by me to read a paper before the 
Medico-Legal Society of New York, upon the subject of 
“ Mechanical Restraint in the Treatment of the Insane.” 
She had for a few years at that time introduced the doc- 
trine of a total abolition of the use of mechanical restraint, 
and was one of the pioneers in the early movement in 
American asylums, some ten years ago, to make an earnest 
effort to see if it could be wholly dispensed with and still 
leave the condition of the inmates improved—a proposition 
that so few superintendents in the United States believed 
possible. 
Her paper was read, and was published in the first volume 
of this journal, and, from my standpoint, exercised an enor- 
mous influence among superintendents of asylums, in in- 
ducing others to make the effort. 
The asylum had a large population, drawn from all 
classes, and the effort which was then successful demon- 
strated that at least this institution had progressed and pros- 
pered without any recourse to mechanical restraint at all. 
I can but feel that in this discussion some extracts from 
that paper will be felt by all earnest inquirers after the truth, 
in its application to the practicle side of the question, to be 
valuable, timely, and deeply interesting. The whole paper 
is entitled, perhaps, to be included, but the scope of the 
article limits me to a few extracts. Dr. Bennett says: 
I will ask leave to pass over the history of former discussions on this 
subject, interesting though they be, and speak to you only out of my own 
experience of what I have seen and known. 
In a service of three years (lacking one month) in the State Hospital 
for the Insane of the Southeastern District of Pennsylvania, something 
over eight hundred female patients have been under observation. This 
experience, while confessedly short and inadequate, is yet believed to 
cover the usual variety of phases of insanity, and more than the usual 
proportion of the chronic, turbulent class so often the subjects of mechani- 
cal restraint. From the county alms-houses, where cases had been ac- 126 
MECHANICAL RESTRAINT IN THE 
cumulating during the years when this District of Pennsylvania had no 
adequate provision for her insane, came a considerable number who had 
been habitually, for months—some even for years—subjected to some 
form of mechanieal restraint. With a new and untried organization, in- 
experienced officers and subordinates—with the general barrenness inci- 
dent to a new hospital, and the almost total absence of the usual devices 
for attracting, diverting, and occupying the large numbers that were 
literally poured into the hospital from all sides, it is believed that the 
conditions have been such as to offer a test more than ordinarily severe. 
During the first fifteen months some little restraint was used experi- 
mentally. Since October, 1881, none has been employed. The results 
of the first three months’ experience were given in the first official report 
of the Department for Women to the Board of Trustees, as follows: 
“Nothing is more certain than that mechanical restraint is incompati- 
ble with ‘ moral treatment, ’ and that resort to it destroys at once any per- 
sonal influence that may be brought to bear. Whether a confession of 
fear on the part of the attendant, or a substitute for the latter’s vigilance, 
it can hardly fail to lessen the bond of respect between patient and attend- 
ant, which it is essential to preserve.” 
And, again, a year later : “ Extraordinary precautions often suggest or 
increase the ‘ violence ’ they are intended to prevent. Freedom of action 
is a wonderful tranquilizer. . . . When to these restless, rebellious 
natures leather bands and canvas jackets say ‘you shall not,’ the antago- 
nistic spirit responds at once to the stimulus. The impulse to do the 
thing forbidden is likely to disappear with the removal of the apparatus 
which suggested it, and if judicious moral influences are brought to bear, 
will not return in any uncontrollable form.” 
Briefly formulated, my convictions, based upon experience, are as fol- 
lows: 
1. Mechanical restraint does not, (in the majority of cases,) “ restrain.” 
[It is not easy, by any mechanical appliance, to so confine a person 
that he cannot accomplish something by muscular effort, and energy, 
checked in one direction, finds some other outlet, with the added impetus 
of resentment and desire for revenge.] 
2. It does exert a positive influence for evil. 
3. It is infinitely easier, safer, and cheaper to do without it. 
From every point of view, then, in the interests of the insane them- 
selves, in the interests of their keepers, and in the interests of public 
economy and of humanity at large, mechanical restraint should be 
abolished. 
But we are again told authoritatively: ‘ ‘ These principles have been 
settled; mechanical restraint is inadmissible in itself; it is to be used 
only when necessary and indispensible for exceptional cases.” 
Just what these “ exceptional” cases are is not laid down ; I have not 
seen them, and I need not tell you that this rule of necessity is apt to be- 
come a sliding-scale, adjusting itself to the convenience or caprice of the 
hour until the “ exceptional ” cases are likely to cease to be exceptional. 
Even admitting, (which I am far from doing,) the existence of the hypo- 
thetical, occasional case which may be benefited by restraint, I would CARE AND TREATMENT OF THE INSANE. 
127 
still hold fast to the principle of the “greatest good to the greatest 
number,” and would unequivocally banish an agent which so certainly 
becomes a centre of evil influence. 
And again: 
You will agree that it is a not uncommon trait of our common human 
nature to want what is beyond our reach—to desire to do the thing for- 
bidden. Especially is this true where the higher control of reason and of 
will is undeveloped, as in children, or in abeyance, as in the insane, who 
frequently are only * ‘ children of a larger growth. ’ ’ 
Trust begets trust-worthiness ; and the reverse is no less true. 
Now if a person, (more or less insane, as the case may be,) sees every 
provision made for his conducting himself like a wild beast, I do not 
doubt that, in nine cases out of ten, he will proceed to justify that expec- 
tation. If, in addition to windows barred, screened, and locked, double 
doors, (perhaps even with the small sliding windows so suggestive,) heavy 
immovable furniture—surroundings calculated to arouse an antagonistic 
spirit—he is perhaps seized upon, and either because of what he has done, 
or of what some one fears he may do, his personal liberty is stiil further 
abridged by some of the many ingenious forms of mechanical restraint, 
what wonder that his evil passions rise and that he proceeds to do all the 
damage possible, and I assure you he can do a great deal; if his hands are 
confined he can kick, if his feet, he can bite, and both with a forocity and 
accuracy of aim most undesirable. 
You can easily see how such a case goes on from bad to worse. The 
restraint continues to excite and intensify the “violence,” which, pro- 
gressively increasing, becomes each day a stronger “justification ” of the 
restraint, and so have been manufactured those notoriously desperate 
cases which are pointed out to curious visitors as having been “ chained ” 
or “caged” for years. Examples of these are, happily, less common 
than formerly, but the county alms-houses still furnish a few, and one 
such has come under my care even during the past year. 
One who has watched the transformation of cases like these under the 
influence of personal liberty and rational methods of treatment can but 
marvel that a principle so plain, so evidently founded in the commonest 
laws of our common nature, should admit of discussion. 
In support of the statement that it is easier and safer to control the in- 
sane by moral than by mechanical means, perhaps I cannot do better 
than to give you notes of some individual cases that have occurred in my 
experience: 
Case i was introduced to us as a most dangerous character, especially 
renowned as a “ kickerhad been continuously restrained in another 
hospital by a leather “muff” for six months preceding admission. The 
propensity to kick everything and everybody within reach being a nat- 
ural consequence of the confinement of her hands, it followed that the 
simple removal of the “ muff” made her at once a less dangerous com- 
panion. By systematic, firm, yet kind, discipline, bad habits were cor- 
rected, self-respect stimulated, and she has become a tractable, working 
patient, although belonging to the hopelessly chronic class. 128 
MECHANICAL RESTRAINT IN THE 
Case 2, an immensely powerful, muscular German woman, one of the 
first admissions to the hospital, brought with her a reputation for ferocity 
calculated to strike terror to the soul of the uninitiated. For months she 
had been chained in a dungeon, the limited space of which scarcely per- 
mitted her to lie at full length on her heap of straw. Through the grat- 
ing of the heavy door was thrust the food, which she must eat as best she 
could, with hands confined. Here, also, the curious were privileged to 
gaze upon this monster in human form, who, with her hair long ago torn 
out by her own hands, and her expression of savage distrust and defiance, 
might well seem something less than human. A year ago I introduced a 
gentleman interested in public charities to this same woman, standing 
in the door of her neat little room, which she invited us to enter and inspect. 
Her thick gray curls surrounded a face strongly-marked and resolute, yet 
not unpleasant to look upon, and her general appearance was such as to 
attract a stranger at once. 
She was led to speak of her former experience, “ And why were you 
locked up in a dungeon ? ” asked my friend. “ Because ” but I can 
not repeat her language. At the mere recollection, a tithe of her old fury 
was aroused, and her mein hinted at the total annihilation of anybody in 
her path. 
‘ ‘ But why did you have those feelings there and not here ? ’ ’ persisted 
the visitor. 
“ Because they locked me up. Would you like to be locked up like a 
beast ? ’ ’ came the answer, with an emphasis which was a whole sermon 
in itself. This patient also belongs to the chronic class, and is probably a 
“life-member” of our little community, but she is a busy worker, she 
has a quick, ready intelligence and warm affections, and her life is not al- 
together an unhappy one. 
Case 3, on admission, had worn the camisole for a length of time. The 
proficiency this woman had attained with her feet was marvellous. To 
open and shut windows and make, (but more often to unmake,) beds was 
easy and her mischievous propensities knew no bounds. This case is a 
good example of the inefficiency of restraint. She has now largely re- 
covered from her mischievous and destructive tendencies, but she, also, 
is a chronic, incurable case. 
Case 4, a young girl of prepossessing appearance, transferred from a 
county almshouse, had been restrained, as to her hands, for several 
months previous to admission. “Too violent for women to manage,” 
was the verdict of the man who had had exclusive charge of her during 
that time. Of this patient I have nothing to say, except that, from the 
time wristlets were removed, while she lived, (she died of phthisis two 
years later,) no reason appeared for such restraint. Hopelessly demented, 
she was yet tractable, grateful for kindness, and kissed the hands of the 
nurse who liberated her. 
Less than a year ago a fire occurred in a county almshouse in the in- 
terior of Pennsylvania, and eighteen female patients were transferred to 
the hospital at Norristown. Of these eighteen, ten came in camisoles, 
not put on for temporary convenience only, as was testified by their CAEE AND TREATMENT OF THE INSANE. 
129 
cramped white fingers, which some of them seemed to have forgotton 
how to use and only learned again by gradual steps. 
Of these ten, one had her feet also shackled. Even with these precau- 
tions the two meq who had her in charge were extremely careful, and 
cautioned others not to go near, saying “ she bites.” Blood-curdling re- 
citals of the fearful deeds she had done, and would still do if left unbound, 
as in the previous cases, to me not wanting. 
I first saw this woman on the second day after admission, (being away 
from home at the time of the unexpected transfer,) and was struck by her 
expression of suspicion and distrust. When asked to shake hands, she 
looked at me some seconds inquiringly, then slowly assented. 
I have never witnessed anything more remarkable than the change that 
occurred in the expression of that woman’s face in the days that followed. 
It is a matter for regret that they were not photographed. It is scarcely 
exaggerating to say that no ordinary observer would have recognized her 
for the same person. An epileptic for years, her mind was hopelessly im- 
paired, but she manifested a childlike affection and gratitude toward all 
who showed her any kindness, and a cheerful smile became habitual. 
That less than a week was sufficient to effect this change must be con- 
sidered evidence of unusual native gentleness and susceptibility to kind- 
ness. 
The above are not exceptional cases selected for the occasion. All 
patients entering the hospital under restraint are at once released, and in 
no case has this treatment failed of good result. But I promised that it 
should be not only easier and safer, but also cheaper, to dispense with 
mechanical restraint. I mean not only that there will probably be less 
actual destruction of property under the tranquilizing influence of per- 
sonal liberty, (the restraining apparatus itself is also costly,) but in a 
much larger sense. When this principle of treatment shall be under- 
stood and extended as it can be, we shall depend less upon costly external 
barriers. Buildings constructed upon the simplest plan will be amply 
sufficient if they are pervaded by the right atmosphere. Probably two- 
thirds of the insane in our hospitals could be kept without bars and locks. 
And she concludes an admirable paper as follows: 
Much depends upon the attendants, upon whom will devolve the carry- 
ing into practice of the spirit of the superintendent. They must be with- 
out preconceived notions, and should be intelligently interested in the 
principles they are carrying out. The insane must be made to feel that 
someone cares for them, and no counterfeit appearance of feeling, how- 
ever plausible, will do. I do not believe the patient can be found so de- 
mented as to be insensible to the voice of kindness, and the influence of 
affection upon some of them is really wonderful. 
Self-respect must be stimulated by respectful treatment, and by encour- 
aging attention to personal habits of neatnest, dress, etc. Perhaps this 
latter is more important among women. I recall now one patient who 
had been in habitual seclusion for a length of time, demented to a degree 
that rendered her apparently incapable of receiving an idea. Taken out 
of seclusion by interested attendants, she was found to be much influenced 130 
MECHANICAL RESTRAINT IN THE 
by personal adornment. A white apron and necktie seemed to exercise 
a restraining influence not inferior to that of a camisole, and she was so 
much engaged in the contemplation of herself as to forget to do any 
worse mischief. I have often remarked a peculiarly tranquil atmosphere 
on Sunday morning, when the “ best dress ” has been universally donned. 
Employment for restless hands is, of course, important. This is espec- 
ially useful in the case of those possessed of destructive tendencies. One 
old lady I remember, who was completely cured of a destructive habit of 
picking at her clothing by being set at work picking over hair for pillows, 
which she did well and apparently enjoyed. 
I have found rocking-chairs to exert a sedative influence upon many, 
especially upon the excitable and those called “ violent.” In one patient 
this proved an excellent substitute for the amusement of tearing her 
dress. 
Out of door exercise is often excellent treatment for excited patients, 
aside from the tonic influence of fresh air and sunshine. [And here I can 
not forbear digressing to say that I can find no place, nor use, for “ airing- 
courts.” In my experience the patients who go out oftenest, for the 
longest distances, and the longest time, are generally those from the most 
excited wards, and no class so much enjoys the freedom of the country.] 
One thought comes to me in closing : There is no more inexorable law, 
nor one of wider application, than that “ action and reaction are equal,” 
each to each. A wrong done operates not only upon the receiver, but 
upon the doer also, and equally. Who will undertake to estimate the in- 
fluence upon ourselves and upon the moral tone of the community at 
large, reacting from a system of repression operating upon a large class of 
our fellow men ; a system calculated to crush out their feeble possibilities 
for good, to foster their baser instincts, and under which they have often 
sunk to depths of degradation and misery almost inconceivable ? 
Dr. Walter S. Fleming is medical superintendent of the 
King’s County Insane Asylum at Flatbush, Long Island. 
His views are as follows: 
Kings’ County Insane Asylum, Flatbush, L. I., 
May 4, 1892. 
Clark Bell, Esq., Secretary Medico-Legal Society, New York. 
Dear Sir:—Replying to your communication of April 30th, would say 
that I think there is a happy medium, which is preferable. Mechanical 
restraint is beneficial in surgical cases to prevent the removal of dressings, 
displacement of fractures, etc.; in other cases to prevent self-mutilation 
and destructive tendencies. In the great majority of cases, however, 
proper exercise, employment, amusements, change of attendants and 
surroundings, will render it unnecessary. 
I think that restraint by attendants renders a patient more irritable, and 
that medicinal restraint, if used to any great extent, materially impairs the 
patient’s physical condition. 
Yours very truly, 
WALTER 8. FLEMING. CARE AND TREATMENT OF THE INSANE. 
131 
Dr. I. O. Tracy, assistant superintendent of the same in- 
stitution, replies as follows: 
Kings County Insane Asylum, 
Flatbush, L. I., May 6, 1892. 
Clark Bell, Esq. , Editor of the Medico-Legal Journal, No. 57 Broad- 
way, New York City. 
Dear Sir:—In reply to your communication of the 30tli ult., I would 
say that, although I do not believe that mechanical restraint is ever an 
absolute necessity in the management of a case of insanity, I do believe 
that at times it is a useful adjunct to other means; and, when properly used, 
I consider it a perfectly legitimate and humane measure. Certainly it 
should never be used indiscriminately, at the discretion of attendants, but 
only upon the order of a physician, and should be ordered by him with the 
same care, and with the same regard to the requirements of the case, that 
he would order a drug; and when so used I think there is as little danger 
of its use being abused as there is of either physical or chemical restraint. 
Yours very truly, 
I. O. TRACY. 
Dr. Stephen Smith was for some years State Commis- 
sioner in Lunacy of the State of New York before the 
passage of the present law creating a Board of Commis- 
sioners. His reply as to his views is as follows: 
New York, May 5, 1892. 
Clark Bell, Esq. 
Dear Sir:—Dr. John Connolly, of England, the pioneer in the abolition 
of mechanical restraint, and in substituting the personal care of an attend- 
ant, affirmed that the effect of a struggle of an insane person with an at- 
tendant was inlinitely preferable to a struggle with mechanical appliances. 
In the former case the patient, when overcome, is subdued, often penitent, 
and usually regards the attendant with respect and sometimes with affec- 
tion. But the mechanical appliance simply creates irritation and engenders 
a spirit of revenge. This statement once seemed to me absurd, but I have 
had abundant opportunities to see its truth verified. 
I began visiting institutions for the insane officially during the period of 
transition from the extreme employment of mechanical restraint to its almost 
entire abolition. I saw patients at one time in straps, strait jackets, 
cribs, manacles, and at another free from all such appliances, but in the 
immediate care of an intelligent and competent attendant. The change 
was often remarkable. I could relate many instances like this : In one 
asylum I found a woman, on repeated visits, confined in a remote room, 
and tied, hands and feet, to the bed. It required several attendants to 
change her clothes, and only on such occasions was she released. On a 
subsequent visit I found her among the other patients, neatly dressed, 
quiet, and orderly. A new attendant on the ward explained the reform. 
On her first visit to the room of the patient she removed all restraint, gave 
her a bath, put on a new dress, brought her out upon the ward, and there 132 
MECHANICAL RESTRAINT IN THE 
was no further trouble. The attendant stated that the patient at first 
resisted her violently, and, with oaths, threatened her life, but she seized 
her with such force that, after a brief but ineffectual struggle, she yielded, 
aud quietly obeyed every command. 
In a State asylum where mechanical restraint had been abolished, I 
witnessed a violent struggle between a powerful woman patient and a very 
slight attendant, but of remarkable agility. To my surprise the attendant 
succeeded in overcoming the patient. I questioned the attendant after- 
wards in regard to her experience with and without mechanical restraint. 
She said she much preferred restraint by attendants, for their influence 
over patients was greatly increased by these direct personal efforts to con- 
trol them. Dr. Connolly was right in his assertion, so far as relates to 
those insane who still have sufficient mental capacity to appreciate their 
surroundings. 
But there is a class of insane so maniacal, or so demented, as to be sus- 
ceptible to no personal influence, and yet they injure themselves or others, 
or destroy clothing, when unrestrained. With these the use of such 
mechanical appliances as so control the use of their hands that they can do 
no harm is a necessity. Again, there are insane so feeble that they must 
be kept in a recumbent position to effect a cure, and yet who persist in 
standing or walking. Confining such patients in bed by such simple means 
as a sheet covering their bodies and fastened to the bedstead, as at the 
Homoeopathic Asylum, is greatly preferable to the constant efforts of an 
attendant. The Utica crib was severely condemned, and yet I have seen 
many a feeble patient restored by being compelled, while in it, to retain 
the recumbent position. 
Whoever enters an asylum ward and attentively examines the insane, 
readily discovers that some require the restraint of an attendant, others of 
padded gloves, or appliances that prevent too free use of the hands, and 
others must be confined to bed. While it has been abundantly proved that 
mechanical restraint has been so employed as to be harmful to the insane, 
it has been equally demonstrated that the treatment of the insane without 
such appliances has resulted in severe injuries to themselves and others. 
The correct position to assume in the use of restraint of the insane is 
midway between the two extremes. Every case should be treated accord- 
ing to its own peculiarities. In general, it would be wrong to apply a 
strait-jacket continuously to a patient who could appreciate his condition 
and be influenced and controlled by an attendant, aud it would be the 
height of folly to require an attendant to hold an imbecile’s hands all day 
to prevent him from destroying his eyes, or to sit by the bedside of a feeble 
patient constantly, to keep him in a recumbent position. 
Truly yours, 
STEPHEN SMITH. 
Dr. C. K. Bartlett, superintendent, of many years’ asylum 
experience, now medical superintendent of the Minnesota 
State Hospital for the Insane, at St. Peter’s, Minn., replies: CARE AND TREATMENT OF THE INSANE. 
133 
Hospital fob Insane, St. Peter’s, Minn, 
May 6, 1892. 
Clark Bell, Esq. 
Dear Sir:—Yours of the 30th ult. was misdirected, and went first to 
New Hampshire, and came to me last evening. I fear my statements will 
be too late for your service, but may, nevertheless, be of little importance 
to the subject. I have read and heard many discussions concerning res- 
traint and non-restraint; but they have always appeared to me nearly use- 
less, from the fact that different persons argued from dissimilar stand- 
points and widely different facts and circumstances. I am satisfied, 
from personal observation in this country and abroad, that the same 
persons who advocate non-restraint in one hospital, if placed in some 
other, would quite as firmly favor and use restraint. A man given unlim- 
ited room, unlimited means, unlimited and experienced help, and a class 
of patients all of one nationality, might find it easy to manage his patients 
without restraint; while, if placed in charge of another—overcrowded, 
consisting of a dozen different nationalities, with limited means, limited 
help, and that mostly untrained and inexperienced, would be strongly in- 
clined to support the system of restraint—to save expense, to prevent 
damage and avoid serious accidents from the conflicts liable to arise from 
the prejudices of nationalities. No humane man will sleep quite soundly 
while he knows there are two and three men sleeping together in the same 
room, without any form of restraint, if he has reason to suspect either one 
is liable to sudden excitement of a homicidal nature. With an experience 
of ten years in an eastern hospital and nearly twenty-four in this, 1 am not 
ambitious to be known as an advocate of either restraint or non-restraint; 
but believe in the judicious use of some form of restraint for special cases, 
and that no other kind of treatment will accomplish equally good results. 
Take, for instance, a case inclined to stand up night and day—exhaustion 
and death will as surely follow as night will succeed day, and at no dis- 
tant period; but compel the patient to remain in a horizontal position, and 
recovery will be the result. I have seen too many cases of this form of 
insanity recover under mechanical restraint to doubt its propriety or its 
beneficial effect. I would write more, but think it unnecessary, as the 
letter of Dr. Ralph L. Parsons, of Grecnmount, N. Y., so nearly expresses 
my sentiments on the matter under discussion. He has had extensive 
experience, and takes a broad and sensible view of the whole subject. 
Respectfully yours, 
C. K. BARTLETT. 
Dr. H. A. Buttolph, one of our oldest asylum superinten- 
dents in the service, for many years superintendent of the 
New Jersey State Asylum, at Morris Plains, writes as fol- 
lows: 
SnoRT Hills, New Jersey, May 7, 1892. 
Clark Bell, Esq. 
Dear Sir:—Agreeably to your request, I send you “short notes’’ of my 
views in regard to the use of mechanical restraint in the treatment of the 134 
MECHANICAL RESTRAINT IN THE 
insane in institutions for their care and cure, if curable, or, if otherwise, 
for their own and the safety and welfare of those with whom they are 
associated. Preliminary to this, however, it seems proper to state, for the 
eye of the general reader, that a very large proportion of the inmates of 
every well-planned, equipped, and managed modern institution, not over- 
crowded, enjoy greater freedom in many respects than while residing in 
their own private homes. 
With regard to those who require additional restraint to that imposed by 
the building in general, it should be alike the duty and privilege of the 
physician in charge, in justice to individual patients, to order that form 
and degree of restraint, whether manual, mechanical, or chemical, or all 
combined, that he regards as best suited to fulfil the indications of the 
case, and without reference to any policy or practice relating to the in- 
mates of the house in general. 
So important is it that the medical officer be allowed to exercise his own 
judgment and freedom in the treatment of those under his charge, that it 
could not, with justice, be said by or of him—as reported in certain quar- 
ters—that he was the only person in the establishment whose head and 
hands were alike under restraint. 
Sincerely yours, 
H. A. BUTTOLPH. 
Dr. Buttolph’s letter illustrates tlie most objectionable 
form in which the advocates of restraint can place the ques- 
tion. 
In acknowledging it, I said to the good Doctor, who is a 
humane and kind-hearted physician, and who would be 
most judicious and considerate from his own standpoint in 
applying mechanical restraint, that the basis suggested by 
him of leaving it to the individual discretion of the superin- 
tendent was, to me, the worst possible criterion that could 
be devised.” 
It is doubtful if any of the superintendents who chained 
and manacled the insane, confined them in dungeons, and 
treated them like wild beasts, for one moment ever consid- 
ered but that they were doing what was absolutely and in- 
despensably necessary for the safety of the inmates and for 
the best interests of the insane. 
It was the intelligence, the Savoir faire of the superintend- 
ents, who, in their discretion, conscientiously made the insane 
undergo all the horrors that Connolly and Pinel helped to CARE AND TREATMENT OF THE INSANE. 
135 
abolish, that these grand men assailed, not their conscien- 
tiousness, not their humane considerations. 
Men like Dr. Buttolpli are like the keepers in the Bicetre 
when Pinel knocked off the mancles. These were good men, 
humane men, but erring and misguided men, and they did 
not know what could be done by other means, other methods, 
till the light of Pinel’s action illumined the paths. 
Dr. Buttolpli felt the force of this criticism and sent in 
response the following reply: 
SnoRT Hitxs, N. J., May 9, 1892. 
Dear Sir:—Replying to yours of this date, I would say that I, at first, 
wrote at considerable length on the subject of special restraint, for certain 
conditions and cases of insanity, in illustration and justification of a prin- 
ciple. Finding that I had exceeded your permission to give “short notes,” 
I laid my paper aside and expressed in brief the principle that should gov- 
ern a medical officer in charge of an institution for the insane, assuming, 
of course, that he is carrying out the principle in detail. An intelligent, 
humane physician, near the close of the century, would not ignore the 
progress made since its beginning. 
To give a single instance, in illustration of the propriety of the rule, I 
suppose the case of a female in an advanced stage of puerperal mania, who 
is still able, from high nervous excitement, to manifest unusual strength. 
The obvious indications are to save the strength of the patient by prevent- 
ing exhausting effort and securing rest in sleep. To accomplish these 
objects, she should be placed in a recumbent position, which should be 
maintained with little interruption for hours, possibly days and nights, in 
succession, according to the necessities of the case, on account of general 
weakness. This would be done for the patient by attendants usually after 
having had a warm bath, during which cold water should be applied to the 
head, to equalize the circulation between the body and brain, and to lessen 
general excitability. 
Should the patient readily yield to the use of these simple means, the 
necessity for the use of more forcible measures may, to a great extent, be 
obviated. In another case, however, the patient may, under the influence 
of high excitement and active delusions, resist the efforts of several attend- 
ants to place her in bed, which being done, a prolonged struggle follows to 
keep her there, during all of which she, perhaps, resists, under the impres- 
sion that she is being attcked with murderous intent. In the meantime 
the physician has prescribed the kind and amount of medicine deemed 
suitable and safe, in the circumstances, to be administered, as heroic treat- 
ment in such condition is seldom admissible. At this stage the manual 
effort to retain the patient in bed having failed, a resort may be had to some 
simple mechanical means, to which the patient will make little or no oppo- 
sition, when she may safely be left under the care of a single quiet attendant 136 
MECHANICAL RESTRAINT IN THE 
or nurse and in very many cases, having received proper nourishment, will 
fall asleep, which is the first step to recuperation and recovery. 
In such a case the physician may be said to have wisely and humanely 
combined his resources—that is of chemical, manual, and mechanical 
restraint to ensure the life of his patient. With this end in view, would 
you restrict him in the use of either one of the measures employed, and if 
so, which and why ? 
Very hastily yours, 
H. A. BUTTOLPH 
There are none so blind as those who will not see. 
I asked Dr. Magnan, at St. Anns, how he would treat a 
certain class of cases that had been named to me by a phy- 
sician who conscientiously believed that restraint was abso- 
lutely indispensable. Dr. Magnan said: “ That he never had 
encountered any difficulty in his great experience in treating 
any case and all kinds of cases without restraint. That he 
could treat them much better and easier and more success- 
fully without than with restraint.” 
Need a reply be made to a physician of Dr. Buttolpli’s 
great experience, who talks of calming and quieting a sick 
and nervously prostrated woman, insane at that, by forcing 
her to lie, as one wrould imagine, in that discarded horror of 
Utica Asylum, an iron crib ? 
To most insane minds it would be like putting potash on 
a raw sore. 
How does Dr. Buttolpli suppose Dr. Peter Bryce would 
treat his suppositious case, or Dr. Alice Bennett, Dr. Wil- 
liam Orange, Dr. W. B. Fletcher, Dr. P. M. Wise, or that 
great body of asylum superintendents whose testimony show 
such appliances absolutely harmful by impeding recovery ? 
Dr. Dwight Shumway Moore, assistant physician at the 
State hospital for the insane at Jamestown, North Dakota, 
sends me his views: 
The State Hospital for Insane, 
Jamestown, North Dakota, April 30, 1892. 
Clark Bell, Esq., New York City. 
Dear Sir:—In deciding how far mechanical restraint of the insane shall 
be done aw ay with, every trace of personal feeling or professional rivalry, CARE AND TREATMENT OF THE INSANE. 
137 
of desire for the distinction of being the originntor of a new therapeutical 
method or novel philanthropical movement, or, on the other hand, of con- 
servative attachment to past customs, ought to be rigorously excluded as 
factors in the formation of judgment. 
Since entering this specialty the greater part of my professional work 
has been in the capacity of assistant superintendent of the North Dakota 
Hospital for the Insane, and under the direction of Dr. Archibald, its 
executive head. It is, therefore, to the observation of his advanced 
methods, and liberal, kindly way of meeting the practical difficulties of 
hospital management, that I owe, and gratefully acknowledge here, my 
growing conviction that the use of restraint, not merely mechanical, but 
manual and chemical as well, is, with the assistance of intelligent, experi- 
enced nurses, comfortable surroundings, absence of all restriction of indi- 
vidual action except in the essentials of discipline and treatment, and the 
cultivation throughout the whole institution of a universal spirit of charity 
and kindly forbearance, almost never necessary. 
But never and almost never are different things. Entirely different. 
‘1 Therefore, all things whatsoever ye would that men should do to you, 
do ye even so to them.” If any man, realizing fully what it is to lose the 
reins of reason, is ready to ask that, under no circumstances whatever, for 
the prevention of injury either to himself or to others, should the power 
to restrain him he given to anyone whatsoever, then let him act according 
to the faith that is in him. As for me, I could not, in all sincerity, make 
such a request. 
Very respectfully, 
DWIGHT SIIUMWAY MOORE. 
Dr. William B. Fletcher, tlie eminent alienist, who sent 
a short letter in the opening of this discussion of mechanical 
restraint, sends the following: 
Dear Clark Bell : 
I could not do more to express myself than poor Cowper to define mental 
diseases. 
The mind is— 
“ A harp whose chords elude the sight, 
Each yielding harmony disposed aright ; 
The screws reversed, (a task which, if He please, 
God in a moment executes with ease,) 
Ten thousand times ten thousand strings go loose, 
Lost, till He tune them, all their power and use.” 
And the following treatment, described by Whittier, is the pith of my 
opinion. 
“ Gentle as angels’ ministry 
The guiding hand of love should be, 
Which seeks again those chords to bind 
Which human woe hath rent apart. 
To heal again the wounded mind, 
And bind anew the broken heart. 138 
MECHANICAL RESTRAINT IN THE 
The hand which tunes to harmony 
The cunning harp whose strings are riven, 
Must move as light and quietly 
As that meek breath of summer heaven 
Which woke of old it’s melody; 
And kindness, to the dim of soul, 
Whilst aught of rude and stern control 
The clouded heart can deeply feel, 
Is welcome as the odors fan’d, 
From some unseen and flowery land, 
Around the weary seaman’s keel.” 
Truly yours, 
W. B. FLETCHER. 
Indianapolis, May 9, 1892. 
Dr. Daniel Clark is one of the foremost Canadian alienists, 
and is at the head of the Asylum for Insane at Toronto, 
Ontario, in the dominion of Canada. 
His letter is valuable in this connection : 
Assylum for tiie Insane, Toronto, Canada, 
May 10th, 1892. 
Clark Bell, Esq., Attorney, 57 Broadway, New York. 
Dear Sir:—1 have not used any mechanical restraint or seclusion in this 
asylum since January 8, 1883, except in two surgical cases. I have not 
found them necessary. Non-restraint is not a hobby of mine, and did my 
judgment lead me to believe that camisoles or mitts were the best for the 
patients, I would not hesitate to resort to them. 
A camisole is a mild form of restraint and has not the Old Adam in it 
that nurses’ hands have. Sentiment in this respect is all well enough, but 
it may go too far, if it hinders the adoption of what discretion may dictate. 
In asylums that have one nurse to every six patients, it is easy to adopt the 
system of non-restraint, but where there is—as in this institution—only one 
nurse to every sixteen patients among the disturbed and excited class, it is 
quite another. However, so far, for eight years I have done very well 
without restraint or seclusion. 
Yours truly, 
DANIEL CLARK, 
Medical Superintendent. 
CONCLUSION. 
The concensus of opinions upon this question among 
medical superintendents of every field of thought will, I feel, 
prove valuable upon the questions involved in this discus- 
sion. 
It has been my purpose to give prominence to the views 
of those who were understood to be the foremost advocates CARE AND TREATMENT OF THE INSANE. 
139 
of the use of mechanical restraints in the care and treatment 
of the insane. 
In New York asylums where restraints have been abolished 
since the death of Dr. Gray, of Utica asylum, where the 
great battle had been fought, where the conflict was at first 
fiercest and most intense, it had been succeeded by a calm 
feeling of restful quiet, and there came, also, the belief that 
the new gospel of peace had become universal. 
This controversy will dispel that illusion, for it was more 
than an illusion. It was a delusion. 
We learn that throughout American asylums there are 
still a few superintendents who both practice and believe in 
the utility and efficacy, I had almost said the humanity, of 
mechanical restraint. 
I think it not only due to truth, but to history, to say that 
the purity of the motives of those who still use this method 
of force and violence as a controlling idea in the method of 
governing and managing the insane cannot be questioned 
and should not be asserted. 
The motives of the superintendents at the beginning of 
the century were alse as pure and as good as those who 
preceded and who succeeded them. It was a question of 
knowledge, of beliefs, of education, of inherited ideas, 
notions, and traditions. The Anglo-Saxon race is one that 
is wedded to its traditions, and changes come slowly into 
that type of mind. 
Our trend of thought is conservative. 
The railway was resisted at first. 
The street-car was fought like an intruder and a danger. 
Every step onward or upward in human progress is, so to 
say, a battle-field. 
These are the mile-stones of human progress. 
What are the fruits that we may justly claim now of this 
concensus of warring opinions ? 140 
MECHANICAL RESTRAINT IN THE 
I will attempt to formulate a few points which, I think, no 
matter how much we differ in other respects, we can agree 
upon as certain truths. 
The discussion shows: 
1. That leading and prominent asylums for the insane 
have been successfully conducted for the past decade, both 
in America and in the British Islands, without any recourse 
to mechanical restraints at all. 
2. The testimony of such men or of such superintendents 
as Peter Bryce, in Alabama; of Dr. William Orange, at 
Broadmoor; of Dr. W. B. Fleming, at Indianapolis ; of Dr. 
Alice Bennett, at Norristown, Pa.; of Wise and Pilgrim, and, 
Blumer, in New York asylums, of Daniel Clark, at Toronto; 
of Maudsley, Bucknill, and Richard son, in England, and of 
scores of others, is given fully, freely, and without reserve 
that they have not in a long experience found it at all neces- 
sary to resort to mechanical restraint in their practice in 
what they deem to be the best management of the institu- 
tions in their charge or over which some of them have been 
in charge. 
3. Those who have not as }ret learned how to accomplish 
similar results; who follow the old and tried and well-worn 
paths; who find it easier, and, as many think, even better to 
use the methods in which they were reared and trained, as a 
rule conscientiously act in what they in good faith believe to 
be the best way. 
4. Much can be said of the crowding of asylums every- 
where existing; of the want of trained and reliable attend- 
ants ; the economy, so called, of limiting superintendents to 
too few and too poorly paid attendants; and the ease with 
which the restraints can be applied to enforce what many 
cannot accomplish without, as explaining why some institu- 
tions have adopted habits, so to say, of restraining patients CARE AND TREATMENT OF THE INSANE. 
141 
that would not be even considered, much less tolerated, in 
others. 
5. While public sentiment is strongly opposed to the use 
of mechanical restraint, both in America and Great Britain, 
that is not enough of itself to condemn the practice. Still, 
at the same time, it can not be ignored by superintendents 
of asylums in countries where the will of the people substan- 
tially rules, even when majorities may be wrong. The great- 
est measure of good to the patient should be the guiding 
star in the horizon of a superintendent’s life. 
The invasion of the private rights of the individual should 
not be resorted to unless absolutely necessary for his own 
good or safety or that of others. To deprive a man of his 
liberty is one thing, but to go further should be carefully 
studied before attempted with the insane, and would, in it- 
self, in most cases, arouse such a resistance and fury as to 
seriously retard the recovery, if not to aggravate the disease. 
6. None among all those who apologize for or defend res- 
traint in this discussion attempt to defend gross abuses. 
None would sooner condemn practices in certain asylums, 
that are generally regarded as abuses, than would Dr. 
Savage or Dr. Hack Tuke. 
The pity of their efforts and influences on American asy- 
lums and superintendents was to hold them up as authority 
for practices they would never sanction, adopt, or excuse in 
others. 
7. There is really less difference between the two extremes 
of thought, so far as disclosed here, than would appear at 
first blush. 
The extremist here limits himself to surgical cases, and a 
very few and very extreme cases. 
No one justifies now that universal use of straight jackets, 
cribs, and other appliances everywhere in general use in 
American asylums only a few years since. 142 
MECHANICAL RESTKAINT IN THE 
No chains are now considered necessary. No locks. 
The fury of the wild beast in the insane is exorcised every- 
where now. 
We are growing more to realize the law of kindness, of 
gentleness, of tenderness, of love even. 
I have seen asylums that were like households, and the 
superintendent the good friend of all. 
8. If good work can be done in one institution without it 
and good results attained, is it not a pertinent useful study 
to fairly and conscientiously examine the methods and imi- 
tate them for any large minded superintendent ? 
And if, as the result of this discussion, I shall have encour- 
aged one of those who now uphold the banner of non-re- 
straint, or influenced one who, used to restraint, honestly 
endeavors to dispense with it, I shall feel a raison d' etre for 
my labor. 
9. Finally, if that great army of unfortunates who are 
without an advocate, who have suffered and endured agonies 
and miseries that cannot be told, if they would be as a class 
and as a body benefited by the total abolition of restraint, 
and the substitution of that system of asylum government 
and management of which, I may say, Dr. Brice and Dr. 
William Orange are the type or exponents, shall we not 
all with one voice say, that the end is one devoutly to be 
wished, and give thanks, as one asylum after another embraces 
the more beneficent and therefore better system of dispensing 
with it altogether. 
THE LAW UPON THE SUBJECT. 
The legal aspect of the question has not been considered. 
The law has given great power to medical superintend- 
ents, but owing to abuses this power has been restricted by 
statutes in England and America. 
As a legal proposition, a superintendent has the right to 
order restraint only when, from symptoms witnessed by CAEE AND TREATMENT OF THE INSANE. 
143 
themselves, they have reason to apprehend the lunatic will 
injure himself or others in person or property. The real 
question is where there is imminent danger. 
Taylor’s Manual of Medical Jurisprudence, 12th 
London edition, 744. 
In Hill vs. Philip the court held that a medical man is 
legally responsible for his treatment of a lunatic. 
Legal Examiner, 1852, pp. 307, 318. 
In Scott vs. Wakem, (Guilford Sun Assizes, 1862,) a medi- 
cal man was sued for damages for placing an insane patient 
under restraint, suffering from delirium tremens, as un- 
necessary and without authority of law. 
In order to provide for the protection of lunatics and for 
the prevention of undue violence or frequency in the 
application of restraint, the present law of England compels 
the keepers of asylums to certify each case or of each 
occasion on which any mechanical restraint is resorted to. 
An omission to make this entry is a misdemeanor, and at 
the Maidstone Lent Assizes, 1851, two medical men were 
convicted and fined for placing patients under restraint 
without having made the entries required by law. (Regina 
vs. Maddock.) 
Taylor’s Manual of Medical Jurisprudence, 12th 
London ed., 747; “Use and Abuse of Res- 
traint,” Jour. Psyc. Med., 1849, p. 240; London 
Medical Gazette, Yol. XVII, p. 556. 
In any American State, if an action was brought by or in 
behalf of an insane patient confined in an asylum against a 
medical superintendent for the use of mechanical restraint, 
the issue would be whether the restraint used was abso- 
lutely necessary to prevent the lunatic from injuring himself 
or others, and the burden of proof would be on the physi- 
cian to show that it was, and that the danger was so immi- 
nent that he was obliged to resort to the restraint as a 144 
MECHANICAL RESTRAINT. 
necessity. This would be a question for a jury to decide, 
and it is quite safe to say that mechanical restraints, as 
applied, coining under such tests before juries in courts of 
law, would, in a large number of instances, be decided 
against the physicians. For, while the courts would hold 
that they had the legal right to employ it, when indispensa- 
bly necessary, in cases of immediate danger, juries would 
decide that it was not necessary, and mulct the physician in 
damages, so jealous is the law of the right of the citizen, 
and the insane man is not, by his misfortune, deprived of 
his legal rights. 
Note.—The recent trial of Dr. Wiederhold, at Kassel, in Germany, for 
resorting to light flagellations of a patient in his charge, suffering from 
hysteria, is quite in point. She had indulged in crying and screaming with 
out cause, so as to disturb the house and other patients. Every effort by 
the physician to quiet her had proved futile, and he had resorted at last to 
corporal chastisement. Dr. Wiederhold exercised his best judgment and 
in the exercise of his discretion resorted to this means to cure her of her 
morbid desire to attract attention. 
Prof. Tuszeck, of Marburg, testified as an expert, “that it was scien- 
tifically inadmissible to use corporal chastisement in the treatment of ner- 
vous patients.” 
Prof. Pellman, superintendent of the lunatic asylum at Bonn, testified 
“that he was personally opposed to the therapeutic use of corporal chastise- 
ment, that it was forbidden absolutely in the German State Asylums, but 
that certain medical men approved of its use.” 
The public prosecutor pressed the case and denied the existence of any 
extenuating circumstances. The court took the same view, and Dr. Wie- 
derhold was sentenced to three months’ imprisonment. 
No one who knows Dr. Wiederhold can doubt but that he acted according 
to his best judgment and for what he believed to be the ultimate good of the 
patient, but the question of personal rights is higher than the mistaken and 
erring judgment of superintendents of asylums, or of medical men, no mat- 
ter how conscientious. HON. A. C. SMITH, 
Lay Judge New Jersey Court of Errors and Appeals. BLOOD AND BLOOD STAINS IN MEDICAL 
JURISPRUDENCE* 
BY CLARK BELL, PRESIDENT OF THE AMERICAN INTERNATIONAL 
CONGRESS OF MEDICAL JURISPRUDENCE. 
The public interest aroused in recent criminal trials, where 
the identification of blood and blood stains became an im- 
portant subject of inquiry, has led me to bring to the atten- 
tion of medico-legal jurists, and the general public, the 
present state of scientific knowledge bearing upon this sub- 
ject, with the decisions of the courts regarding it; for the 
purpose or showing as well what can be ascertained by 
scientific enquiry as to discriminating between human blood 
and that of other animals, as to illustrate in a familiar way 
what is now known, and can be demonstrated by science, 
with the methods employed by the most skillful, in deciding 
such questions, so as to make it easily understood by all 
intelligent persons. 
BLOOD. 
Blood in all vertebrate animals consists of small corpuscu- 
lar structures floating in what has been called blood Plasma 
or Liquor Sanguinis, sometimes called blood Serum. These 
consists of red corpuscles, white corpuscles, and blood 
plates, so-called. 
The red blood corpuscles afford the best means and the 
most interesting study of these questions in forensic medicine 
by the microscope and the micrometer. 
Swammerdam first saw them in the blood of the frog in 
1658, Malpighi in that of the hedgehog in 1661, and Leeu- 
THE RED CORPUSCLES. 
‘Read before the Medico-Legal Society, May session, 1892. 
‘Read before the American Microscopical Society at Rochester, August 11, 1892. 146 
BLOOD AND BLOOD STAINS 
wenliock in the blood of man in 1673. Perhaps no subject 
in Morphology has been more carefully studied, but up to 
the present time we have learned comparatively nothing 
of the structural arrangement of the red blood corpuscles; 
nor can we explain any considerable number of the phenom- 
ena which they display. 
FORM, COLOR, AND STRUCTURE 
Two distinct forms have been discovered in the red cor- 
puscles of blood. 
1. The circular disc occurs in all the mammals except the 
camel and auchenia. 
2. The eliptical or oval discs are seen in the blood of all 
birds, amphibia, most fishes and of mammals, the camel and 
the auchenia. The microscope enables the observer to dis- 
tinguish the blood of birds, fishes, and reptiles, from mam- 
malian blood (which includes that of the human being) by 
the organic structural difference in form. 
The oval or eliptical corpuscles have also another distin- 
guishing feature. They each have a central nucleus which 
gives them an apparent 
prominence in the center. 
The red blood corpus- 
cles, while always red in 
appearance, are round, 
not like the orange, but 
round like the silver dol- 
lar, and they revolve in 
the Liquor Sanguinis 
with their flat sides to- 
gether like roleaux of 
coin, vide Fig. 1. 
This nucleus in the 
eliptical or oval corpuscle 
stands out, is prominent, and may be compared to the disc 
Fig 1. 
RED BLOOD CORPUSCLES. 
a. Flat side presented. 
b. Single side view presented. 
c. In roleaux like coin. IN MEDICAL JURISPRUDENCE. 
147 
formed by placing two saucers together with the convex 
surface presented outwards, vide Fig. 2. 
In the circular discs they have no 
nucleus and appear depressed in the 
center. 
This nucleus does not exist in the 
corpuscles of the mammalia, even in 
the two exceptions named, and this is a 
difference so easily shown by the micro- 
scope that the observer can at once 
state positively from the form and 
structure alone, whether the red cor- 
puscles are oval and nucleated, and so not from the blood 
of man or mammalia—with the exceptions named—and if so 
found, can assert positively that they belong to birds, fishes, 
reptiles, some of the camel tribe, or the amphibia. 
Pig. 2. 
side view of oval disc. 
b. Knd view, showing nucleus. 
WHITE CORPUSCLES AND BLOOD PLATES. 
There are three kinds of blood corpuscles: The red, which 
I shall chiefly consider in this paper, the white corpuscle, 
and the so-called blood plates; the latter having been only 
recently discovered by Hayem in 1878. 
( Recherches Sur 1* Anatomie Norm et path du sang by Hayem, Paris, 
1879. Comptes Rendus de 1’ academie de sci 1882, 18 Julie, and by Biz- 
zozero in 1882.) 
Vide his article on Blood in his Klienische Microscopic, 
1887. Also Virchow’s Archiv, 1882, Bd. 90, p. 2G1. 
These blood plates are demonstrated to be the important 
factors in the clotting of blood. Studies of these blood 
plates have been made by William Osier, and by him pub- 
lished in the Phil. Medical Times of April 3 and October 17, 
1886, and by Welch. Vide :— 
“ The Structure of the White Thrombi.” Transactions 
Pathological Society of Philadelphia, Vol xiii, (1887). 
They number about one-twTentieth part of the blood cor- 
puscles. 148 
BLOOD AND BLOOD STAINS 
But little as yet is known concerning them, their charac- 
teristics or structure, or how the)7 differ in different animals. 
So far as now known they throw no light upon the subject 
of our present inquiry and science has yet little or no aid 
from them on the question of discrimination, from those of 
other mammals, though research may, in the near future, 
add to our knowledge as to their difference in number and 
appearance in various animals, and as to other character- 
istics. 
The white corpuscles are few in number, averaging only 
about one to five hundred of the red corpuscles. 
They are spherical in shape, of a pale, milky appearance, 
have a peculiar amoeboid motion, and assume varied shapes. 
They also have nuclei. They are of a comparatively uniform 
size in all vertebrates, being from 1-2700 to 1-3000 of an inch 
in diameter, so that a contrast of their diameters throws no 
light upon the present inquiry. 
Prof. Formad claimed that the white blood corpuscles are 
the progenitors of the red ones. 
So far as present scientific knowledge goes, they furnish 
no source of information in discriminating between the 
blood of man and other animals. 
The specific gravity of the red corpuscles is stated by high 
authorities to be about 1088; that of serum 1028. 
Dana has calculated that the ratio of the weight of the 
total bulk of blood to the total weight of the body is in man 
1-13, and the same in the dog, but less in other domestic 
animals:—the cat, 1-14; horse, 1-15; rabbit, 1-18; guinea 
pig, 1-19; calf, 1-21; sheep, 1-24; pig, 1-26; ox, 1-29. 
Formad claims, from his own researches, made upon red 
blood corpuscles, that they have in fact no nuclei; that they 
are not actually red, but yellow; that the apparent nuclea- 
tion is due to their biconcavity, on account of which the center 149 
IN MEDICAL JURISPRUDENCE. 
of the corpuscle appears dark in one focus with a light per- 
iphery, while in another focus the reverse occurs. 
He also claims to have demonstrated by the test of the 
venom of serpents that they have no cell wall or membrane, 
and that, in fact, what seems a cell wall or membrane is only 
the outer hardened layer of the protoplasm of the corpuscle. 
METHODS OF INVESTIGATION. 
Three methods of investigating blood have been employed 
by scientific observers, to which I shall briefly advert, as 
each furnishes its peculiar evidence upon the subject of the 
present inquiry, which is to determine how far science lends 
her aid to detect the existence of blood in medico-legal 
cases, and when found, to determine how far it is possible to 
discriminate between the blood of man and that of other 
animals:— 
1. Chemistry. 
2. The spectroscope. 
3. The microscope and its allies, the micrometer, and the 
micro-photograph. 
The highest chemical authorities unite in the statement 
that there are no ascertained chemical differences between 
the blood of man and that of other animals. 
CHEMISTRY. 
THE GUAIACUM TEST. 
This test, discovered by Dr. Day, of Australia, is confirmed 
by Taylor, Tidy, Reese, Formad, Wormley, and others, and is 
a beautiful test for blood or blood stains, to show the pres- 
ence of blood, and to distinguish them from other stains and 
substances. 
This test is thus made: Take the tincture of guaiacum, 
dissolve it in rectified spirits of wine and add peroxide of 
hydrogen dissolved in ether. 150 
BLOOD AND BLOOD STAINS 
If in this is dropped a solution containing blood it will 
turn the tincture blue in a few seconds. While there are 
several organic substances that will turn guaiacum blue, still 
this is a practical and valuable test. The force of the ex- 
periment lies in the fact that while blood alone will not 
blue guaiacum, in the presence of organized ether (peroxide 
of hydrogen dissolved in ether) the blue color at once ap- 
pears. 
Prof. C. Meymott Tidy describes this test as follows: 
“Wet the blood stain with freshly prepared tincture of guaiacum, and 
then add a small quantity of an etheral solution of hydroxyl. (To pre- 
pare the tincture of guaiacum, wash the tears of guaiacum resin first with a 
little alcohol and then dissolve the pure unoxidized resin by shaking up 
with a little fresh spirit. The etheral solution of hydroxyl is prepared by 
mixing together equal parts of ether and hydroxyl. The ether is however 
not necessary for the reaction). If the stain be blood, a characteristic blue 
tint will be produced. 
“ If the material stained be of such a color as to obscure the reaction, add 
the several reagents, and afterwards press the fabric between two pads of 
white blotting paper, when the blue color will be absorbed by the paper. 
A number of impressions may in this manner be obtained, and the reaction 
be rendered apparent. 
“ If the blood be fresh the reaction may be obtained by simply treating 
a solution of the coloring matter in cold distilled water with the guaiacum 
and hydroxyl. 
“To detect blood in urine the following process has been suggested: 
Mix together, in a test tube, equal parts of turpentine and tincture of 
guaiacum. Then add the urine so that it may flow to the bottom of the 
tube. The guaiacum resin which now separates, if blood is present, becomes 
an intensely blue color. 
“ In this test the blue color results from the oxidation of the guaiacum 
resin. But it is important to note that guaiacum is blued by a great num- 
ber of substances, such as by gluten, milk, and the fresh juice of various 
roots and under-ground stems, (horseradish, colchicum, carrot, etc.); 
also by nitric acid, chlorine, the chlorides of iron, mercury, copper and 
gold, the alkaline hypoclorites, and a mixture of hydrocyanie acid and sul- 
phate of copper; also by pus, saliva and mucus mixed with carbolic acid 
creosote, etc., etc. 
“ Although the guaiacum test is neat and beautiful, it should never be 
relied upon Ay itself alone as positive proof of a stain being blood.’’— 
(i Tidy’s Legal Medicine, 221.) 
Prof. Reese says regarding this test: 
“ It is a remarkable fact, as discovered by Schonbein, that autozone, as 
found in the peroxide of hydrogen (in which the oxygen is in the positive 151 
IN MEDICAL JURISPRUDENCE. 
state), has no effect at all in changing the guiac resin to a blue color, 
moreover while the resin is blued by a variety of mineral and organic sub- 
stances, the coloring matter of the blood has no effect upon it. 
“ The guaiacum test then depends upon the fact that while the blood has 
no power to oxidize or blue the resin, the presence of peroxide of hydro- 
gen (autozone), which itself has no power to oxidize the guaiacum, causes 
the resin then to be oxidized by the blood and the blue color appears.”— 
Reese Med. Juris, and Tox., (1891,) p. 131. 
The same authority says: 
“ Objections have been raised against this test on the ground that other 
substances besides blood will produce a blue color in the presence of guiac 
and peroxide of hydrogen, such as saliva, bile, and red wine ; but as re- 
gards the two former, their color should at once distinguish them from 
blood, while the latter substance requires some hours' exposure to produce 
the same results ; whereas in the case of blood the effect is immediate.” 
And he further says: ‘‘That the chemical tests will not distinguish arte- 
rial from venous blood, nor human from other blood.” 
He also asserts that the claim made by M. Barruel, ‘ ‘that if blood be shaken 
up with an excess of pure sulphuric acid a peculiar odorous principle will 
be evolved, resembling the particular animal from which the blood was 
obtained,” has been disproved by recent investigations and is no longer 
regarded as reliable.—Reese. Med. Juris, and Tox., pp. 132 and 133. 
HAEMATIN CRYSTALS. 
ftyB 
JtyC, 
Haematin Hydrochoride. 
X400 diameters. 
Haematin Hydrochloride from 1-500 grain 
of blood. X 750 diameters. 
Take a blood clot, or fragment of one, and evaporate it to 
dryness, with an excess of haematin (hydroclorate of haema- 
tin) and a trace of chloride of sodium. Then add more 152 
BLOOD AND BLOOD STAINS 
acetic acid and repeat the evaporation, but more slowly. 
Then examine the residuum under a microscope of at least 
300 to 500 diameter power. Crystals will be formed of well- 
known and well-defined character and shape. 
Figures B and C are examples of these cryrstals, which I 
am permitted, by Prof. Theodore G. Wormley, of Phila- 
delphia, to use, from his work, Micro Chemistry of 
Poisons. 
Prof Formad, of Philadelphia, says of haematin crystals: 
“That they may be produced by the addition of glacial acetic acid and 
sodium chloride to dried blood. 
“ A few granules of dried blood are pulverized on a glass slide, together 
with a few granules of salt; having covered it with a glass circle, a drop of 
the acid is allowed to flow under; the slide is then submitted to heat, 
when the peculiar crystals appear.”—(Comparative Studies of Mammalian 
Blood, by Formad, p. 8.) 
This test has been called “ Teichman’s Crystals,” after its 
discoverer. Formad says it can be relied upon as indicating 
the presence of blood, but cannot be relied upon as indicating 
the kind of blood. 
Prof. Tidy describes these crystals and this test as 
“Teichman’s Test as modified by Neuman.” He says : 
“ Thoroughly rub together the dried blood and common salt. Treat 
the mixture with glacial acetic acid and cautiously evaporate the solution 
until solidification commences. 
“ Cool the slide rapidly and examine with % inch objective, when 
crystals of haematin (brownish black or reddish brown rhomboids, or 
tabular crystals), together with crystals of sodic chloride (transparent 
tubes) will be apparent. 
“ The experiment may also made without employing sodic chloride. 
(Casper.) 
“ In the case of a stain it should be placed on a glass slide and mois- 
tened with a solution of sodic chloride. 
“ It should then be covered over with a large thin glass, and glacial acetic 
acid allowed to run under the edge. The liquid is then to be heated to dry- 
ness at a boiling temperature, and the slide allowed to cool. When cold, 
rhomboidal crystals of hydrochlorate or haemantin, together with crystals 
of sodic chloride, dispersed through irregularly shaped albuminous masses, 
will be seen. 
“ It is stated that the character of the network in which the crystals are 
dispersed varies with different animals, forming characteristic pictures. IN MEDICAL JURISPRUDENCE. 
153 
(American Journal Medical Science, LX, p. 42.”)—1. Tidy Legal Medicine, 
p. 222. 
These several tests, while reliable in determining whether 
the matter examined contains blood or not, are of no value, 
and throw no light whatever upon the question as to whether 
it was the blood of man or of animals that was examined. 
THE SPECTROSCOPE AND SPECTRAL ANALYSIS. 
This instrument furnishes valuable evidence in murder 
trials, to determine the 
presence or existence of 
blood in any case of doubt. 
The liquid, to be exam- 
ined diluted, is placed in a 
glass tube for examination, 
under a good light. It 
should be clear and great 
care taken with the spec- 
tral apparatus. Two tubes 
should be examined to- 
gether for contrast, one 
containing blood and the 
other the liquid in question. 
Any animal blood can be 
used for this test. Attach the spectral eye piece to the 
microscope and analyze the light as it traverses the clear 
solution. If the red liquid owes its color to recent or oxidized 
blood two dark absorption bands will be seen breaking the 
continuity of the colored spectrum. These bands are near 
the junction of the yellow with the green rays, and in the 
middle of the green. If the blood is quite recent and of a 
bright red color the two absorption bands will be distinct 
and well defined. (Taylor’s Manual of Medical Jurispru- 
dence, 12th London Edition, 272.) 
I am indebted to Lea Brothers & Co., of Philadelphia, for 
Fm 7) 
Sorby’s spectroscope eye piece 154 
BLOOD AND BLOOD STAINS 
the privilege of reproducing Dr. C. Meymott Tidy’s beautiful 
plate representing this test. Vide Tidy Legal Medicine for 
same. 
No matter how small the quantity of blood, if any red col- 
oring matter remains, in good, careful hands, in the min- 
utest test, the presence can be certainly indicated. 
Sorby says that a spot of blood of only one-tenth of an 
inch in diameter, or a quantity of red coloring matter equal 
to only the 1000th paid of a grain was sufficient to give con- 
clusive evidence of the presence of blood by spectral analysis. 
And the late Dr. Richardson, of Philadelphia, stated that 
he was able, by a still more delicate process, to detect the 
3000th part of a grain of blood, on an axe handle supposed 
to have been used in a case of murder. 
• THE MICROSCOPE AND ITS POWERS. 
We have shown how readily mammalian blood can be 
distinguished from the oval and nucleated corpuscles by this 
marvelous instrument. 
We shall conclude what we have to say upon the question 
as to whether, by the aid of the microscope of high powers, 
there is any means now known to science of distinguishing 
between the blood of man and the domestic animals. 
It was claimed by Taylor, one of the highest authorities, 
that, in his day, no certain method existed of distinguishing 
human from other mammalian blood, when it had been once 
dried on an article of clothing, or upon a weapon, and his 
editors have, since his death, made the same claim. (Tay- 
lor, 12th London Edition, p. 279.) 
The learned editor of Taylor’s Medical Jurisprudence, to 
whom I refer, Dr. Thomas Stevenson, of London, quotes in the 
same volume approvingly the valuable labors of Dr. Rich- 
ardson, of Philadelphia, as reported in American Journal of the 
Medical Sciences, July, 1874, that by the use of the micro- 
scope of higher powers, up to 750 diameters, and by other BLOOD SPECTRA. 
A D E F 6 
] 
2 
3 
f 
A X> E F G 
/. Spectrum of Scarlet Haemoglobin, (Oxy hcenioglobin,) 
2. Spectrum of reduced Hcemoglobin. 
j. Spectrum of blood after prolonged exposure to air, 
(Methamoglobin.) 
4. Spectrum of reduced Haematin. 
From Tidy's Legal Medicine. IN MEDICAL JURISPRUDENCE. 
155 
appliances, he had been able to distinguish, under favorable 
conditions, the blood of man from such animals as the ox 
and pig and to give evidence thereon in certain trials for 
murder. Taylor and other observers before Richardson had 
only used 300 to 800 diameter powers. Vide figures 3 
and 4. 
Fig. 3. 
Fig. 4 
Red Blood Corpuscles, 
315 diamaters. 
a. Red Blood Corpuscles, 315 diamameters. 
b. White Corpuscles. 
The method is to contrast the diameters of the red blood 
corpuscles of man with each of the mammalian animals. 
Fig* &• 
Fig. 6. 
Human Corpuscles, 650 diameters. 
1-3500, Dr. Seiler’s measurements, 
Amer. Med. Times, Feb’y, 1876. 
Pig’s Corpuscles, 650 diameters. 
1-4250, Dr. Seiler’s measurements. 
The diameter of the red corpuscle of each mammal has 
been ascertained approximately by averages. The difficulty 
lies in the exactness of the standard. For example, the aver- 
age diameter of the human red blood corpuscle is l-3200ths 
of an inch. Vide fig. 5. Reese says the maximum is 1-2000, 156 
BLOOD AND BLOOD STAINS 
Ftg. 7. 
minimum 1-4000. Dr. Stevenson 
places the maximum at 1-3000 and 
the minimum l-5000ths of an inch. 
Gulliver, a high authority, places 
the average human red corpuscle 
1-3200. The Medico-Legal So- 
ciety of France, in 1873, 1-3257; 
Wormley, 1-3250; Masson, 1-3257; 
Formad, inT888, 1-3200. 
, All unite in the statement that 
the human corpuscle is larger than 
those of the domestic animals. 
These are measurements upon fresh 
blood, which has not been allowed 
to dry on animal or vegetable 
stuffs. 
The average diamater of the red 
corpuscles of the blood of the 
sheep is 1-5000, the goat 1-6366, 
and these are so much smaller than 
those of man that a microscope of 
low power would certainly discrim- 
inate them by the size of the red 
corpuscle from those of man, as 
also those of the horse, 1-4600; 
the cow, 1-4500; the cat, 1-4004; 
the pig, 1-4230; and the mouse. 
1-3814. Vide figs. 7, 8, 9. 
The greater difficulty arises with 
those animals whose red corpus- 
cles approximate nearer in size to 
those of man, such as the dog. 
Taylor says the average diameter 
of the red blood corpuscles of the 
Red Blood Corpuscles magnified 319 
diameters. 
a. The Dog. b. The Mouse. 
c. The Rabbit. d. The Ass. 
F*g. &• 
Red Blood Corpuscles magnified 319 
diameters. 
a. The Cow. b. The Dog. 
c. The Ox. d. The Cat. 
Fig. 9 
Red Blood Corpuscles magnified 319 
diameters. 
a. The Horse. b. The Sheep. 
c- Common Fowl. d. Salamander. IN MEDICAL JURISPRUDENCE 
157 
dog are 1-3540; Reese, 1-3500; Formad, 1-3580; Wormley, 
1-3561 ;r Gulliver, 1-3532. 
ox an!T human 
Blood Coipusoles Side by Sid?. Magnified 500 Diameters. Micrometry 
illustrated. Plioto-Micrograpb by Dr. Seller. 
Dr. William J. Lewis, of Hartford, in a scholarly inaugu- 
ral address as President of the American Society of Micro- 
scopists, delivered in August, 1889, says of the dog: 
“ Unfortunately in the dog the red corpuscles so closely resemble those of 
man that it is difficult to distinguish between them. 
“ Out of two hundred corpuscles from the blood of man, and an equal 
number from a dog, Dr. J. P. Bradwell found that those measuring 1-3200 
of an inch, forty-six were from the man and six from the dog. Of those 
measuring i-3300ths of an inch, thirty-seven were from the man and sev- 
enteen from the dog. Of those measuring 1-3400 of an inch, fourteen 
were from the man and twenty-three from the dog. It will thus be seen 
that although the average human blood corpuscles is slightly larger than 
that of the dog, the variations in size overlap in measurement so as to 
make it unsafe to express a positive opinion when the question is confined 
to distinguishing between human or dog’s blood. The blood of the guinea 
pig is still more difficult to determine in comparison with that of man. 158 
BLOOD AND BLOOD STAINS 
“From careful measurement of the red corpuscles in a given specimen, 
if found to average the same as those of man, a positive opinion may be 
expressed that the blood did not come from the sheep, ox, horse, pig, or 
goat, the corpuscles in those animals being so much smaller as to render 
the distinction easy.” 
Prof. Reese, now perhaps one of our highest American 
authorities, claims that Dr. Richardson has demonstrated 
the possibility of distinguishing between human blood and 
that of the horse, cow, sheep, pig, and goat, with certainty 
and precision. That by employing very high microscopic 
powers, such as l-30th of an inch objective, magnifying with 
a micrometer eye-piece over 3000 diameters, the human red 
blood corpuscle appears about 9-8tlis of an inch in diameter, 
whilst those of the ox and sheep are about 5-8tlis of an inch 
in diameter, indicating a very obvious difference in their re- 
spective sizes, and that the use of the ordinary powers (500 
or 600 diameters) fail entirely to recognize the difference.— 
(Reese Medical Jurisprudence and Toxocology, p. 132, 2d 
Edition Text Book, 1889.) 
Since the researches of Dr. Richardson great advances 
have been made by able observers, and it is now generally 
believed, that with a skilled and careful microscopist, and a 
good instrument of high powers, it will generally be 
possible to diagnosticate a human blood stain from that of 
any of the lower animals, with the possible exception of the 
guinea pig and the opossum. This, however, has not yet 
been conceded by some very high authorities, both American 
and European. 
In 1880 Prof. Reese, as editor of the 8tli American Edition 
of Taylor’s Medical Jurisprudence, Philadelphia Edition, 
said: 
“Prof. Richardson’s microscopic investigation of blood stains are now 
always conducted with powers much higher than those mentioned by 
the author. (Taylor, speaking of powers of from 300 to 500 diameters.) 
I have examined with him bloodstains from man, the pig, the ox, and the 
sheep, with powers varying from 1200 to 1800 diameters, and can testify 
to the obvious differences which unequivocally distinguish human blood IN MEDICAL JURISPRUDENCE 
159 
from that of the above mentioned animals, by the use of these 
high microscopic powers. Prof. Richardson’s observations have 
afforded material aid to the cause of justice in several noted 
homicide trials, where the identification of suspected blood spots 
was a necessary factor in the evidence. By the employment 
of these high powers there is no difficulty in positively distinguishing 
between the human blood corpuscles and that of any animal whose cor- 
puscle is less than i-4oooth of an inch.” 
In inviting Prof. Reese to be present and partake in the 
discussion of this paper before the Medico-Legal Society, I 
requested him, if unable to attend, to give his views upon the 
general question of discrimination between the blood of man 
and the domestic animals, and as to the opinions expressed 
by him in 1880, above referred to. 
His reply cannot fail to be of interest to the members of 
this Society and all students of the subject: 
‘‘Atlantic City, N. J., April 30, 1892. 
Mv Dear Mr. Bell:— 
I have duly received your two communications. I do not think I can 
answer you more satisfactorily than referring you to the last edition 
(third) of my work on Medical Jurisprudence (1891). If you will kindly 
excuse the (apparent) egotism of my so doing, for my article there on 
‘‘Blood and Blood Stains,” I think you will find the subject fully dis- 
cussed and written up to the present census of scientists and medical ex- 
perts. 
Certainly (as stated in Taylor’s) there is no difficulty in detecting cor- 
puscles much smaller than 1-4000 of an inch as, e. g., those of the horse, 
sheep, and goat. The present pretty general idea seems to be that whilst 
it is admitted that a skillful microscopist can certainly distinguish between 
a human corpuscle and one of a horse, cow, pig, sheep, and goat (domes- 
tic animals with which it would be likely to be confounded), still in a 
murder trial, where human life is at stake, the expert is hardly warranted 
to swear that the blood stain is anything more than that of a mammal. 
Sincerely yours, 
JOHN J. REESE.” 160 
BLOOD AND BLOOD STAINS 
FRESH HUMAN BLOOD. Red Blood Corpuscles, Magnified‘2.?50 D1 
amelcrs-. Photo-Micrograph. 1-18 Zeiss Horn Oil Immersion 
and Projection Eye-Piece. 
The studies of Prof. 
Formad, of Philadel- 
phia, are perhaps of as 
great interest as those 
of any recent observer, 
especially with high 
powers. His method 
with dried blood is 
first to expose it to a 
gentle, moist heat from 
one to ten days, ac- 
cording to the age of 
the stain. 
iv SHEEP. (1-6U00.) ‘i inches. 161 
IN MEDICAL JURISPRUDENCE. 
“A small granule of the suspected blood on a fibre from the blood 
stained fabric is placed on a glass 
slide in a drop of 30 to 35 per cent, 
solution of caustic potash and cov- 
ered with a glass slide. If the 
blood stain was recent the disinte- 
gration of the clot commences at 
once, and the isolated corpuscles 
separate and swim swiftly through 
the liquid if the stage of the micro- 
scope is slightly inclined.” 
Prof. Formad has recently 
claimed that by a still higher 
amplification, obtained by 
re-photographing single cor- 
puscles of different animals 
(prepared in the same manner as Prof, Richardson’s, and 
under similar projections) he has secured most singular and 
striking results. 
GOAT (1-6100.) 1 3-f* inches. 
' v -M AN.ld-3200.) 3 t-S Inches. 
Thus by enlargement to 10,000 diameters, Formad claims 162 
BLOOD AND BLOOD STAINS 
to have obtained the following photographic measurements: 
The human corpuscles, enlarged to inches in diameter; 
Fig. H>. OX. (1-4200.) 2 13 Inches 
DOG. (1-3500.) 2 4 5 nu'l e> IN MEDICAL JURISPRUDENCE. 
163 
guinea pig, 3 inches; dog, 2 4-5 inches; ox, 2f inches, 
sheep, 2 inches; goat, If inches. Under such tests, and the 
light thrown upon the subject by these able observers, with 
these very high powers, the careful observer would, as he 
claims, be able to state that the corpuscles were not those of 
the sheep, the goat, the horse, the cow or ox, and probably 
the dog, as well as most of the mammals, except the guinea 
pig and opossum. 
The tables of Prof. Wormley as to the average diameter 
of the red corpuscles of the mammalia may be quoted as of 
high value. He has made illustrations of the apparent 
size of red corpuscles, under an amplification of 1150 diam- 
eters, expressing the average diameters in vulgar fractions, 
thus—3250 equals 1-3250 of an inch. This table of illustra- 
tion shows the corpuscle of man, the dog, mouse, ox, sheep, 
and goat. 
BLOOD. 
Reptii.es. 
Wormley. 
Gulliver. 
Length. 
Breadth. 
Length. 
Breadth. 
1-1250 
1-2200 
1-1252 
1-2216 
1-1231 
1-1882 
Boa-constrictor 
1-1245 
1-2538 
1-1440 
1-2400 
Viper 
1-1274 
1-1800 
Lizard 
1-1555 
1-2743 
Batrachians. 
YVormley. 
Gulliver. 
Length. 
Breadth. 
Length. 
Breadth. 
1-1089 
1-1801 
1-1108 
1-1821 
Toad 
1-1043 
1-2000 
Triton . 
1-848 
1-1280 
Proteus 
1-400 
1-727 
Amphiuina tridaetylurn 
1-358 
1-622 
1-363 
1-615 164 
BLOOD AND BLOOD STAINS 
F18HE8. 
Gulliver. 
Length. 
Breadth. 
Trout 
1-1524 
1-2460 
Perch 
1-2099 
1-2824 
Pike 
1-2000 
1-3555 
Eel 
1-1745 
1-2842 
Lamprey 
Circular. 
1-2134 
Nucleus 
1-6400 
Average Size of the Red Blood- Corpuscles. 
Mammals. 
Wcrmley. 
Gulliver. 
Mammals. 
Worm ley. 
Gulliver. 
Man 
1-3250 
1-3200 
Rhinoceros .... 
1-3649 
1-3765 
Monkey 
1-3382 
1-3412 
Tapir 
1-4175 
1-4000 
Opossum 
1-3145 
1-3557 
Lion 
1-4143 
1-4322 
Guinea-pig .... 
1,-3223 
1-3538 
Ocelot 
1-3885 
1-4220 
Kangaroo .... 
1-3410 
1-3440 
Mule 
1-3760 
Musk-rat .... 
1-3282 
1-3550 
Ass 
1-3620 
1-4000 
Dog 
1-3561 
1-3532 
Ground-squirrel . . 
1-4200 
Rabbit 
1-3(553 
1-3607 
Bat 
1-3966 
1-4175 
Rat 
1-3652 
1-3754 
Sheep 
1-4912 
1-5300 
Mouse 
1-3743 
1-3814 
Ibex 
1-6445 
Pig 
1-4268 
1-4230 
Goat 
1-6189 
1-6366 
Ox 
1-4219 
1-4267 
Sloth 
1-2865 
Horse 
1-4243 
1-4600 
Platypus (duck-billed) 
4-3000 
Cut 
1-4372 
1-4404 
Whale 
1-3164 
1-3093 
Elk 
1-4384 
1-3938 
Capybar'a .... 
1-3130 
Buffalo 
1-4351 
1-4586 
Seal 
1-3281 
Wolf (prairio). . 
Bear (black) . . . 
1-3422 
1-3600 
Woodohuck .... 
1-3484 
1-3656 
1-3693 
Musk-deer ..... 
. . . 
1-12325 
Hyena 
1-3044 
1-3735 
Beaver 
1-3325 
Squirrel (rod) . . . 
1-4140 
1-4000 
Porcupino .... 
1—3201 
1-3369 
Raccoon 
1-4034 
1-3950 
T, f long dlara. . 
LIamai short “ . 
1-3361 
Elephant .... 
1-2738 
1-2745 
1-640S 
1-6229 
Leopard 
1-4390 
1-4319 
Camel f lons dia“- * 
1-3331 
1-3123 
Hippopotamus . . 
1-3530 
1-3429 
amo1 | short “ 
1-5280 
1-5876 
Biass. 
Wormley. 
Gulliver. 
Leugth. 
Breadth. 
Leugth. 
Bread ih. 
Turkey . 
Pigeon 
Sparr&w . 
_ 
1-2080 
1-1894 
1-1955 
1-1892 
1-3483 
1-3444 
1-3504 
1-3804 
1-2102 
1-2045 
1-1937 
1-1973 
1-1836 
1-2005 
1-2140 
1-1763 
1-3466 
1-3598 
1-3424 
1-3343 
1-3839 
1-3470 
1-3309 
1-3500 
1-4076 IN MEDICAL JURISPRUDENCE. 
165 
The general conclusion reached by Prof. Wormly is “ That 
the microscope may enable us to determine with great certainty 
that a blood is not that of a certain animal and is consist- 
ent with the blood of man; but in no instance does it in 
itself enable us to say that the blood is really human, or in- 
dicate from what particular species of anbnal it was de- 
I 
rived'' 
Prof. Formad has compiled a comparative table of the 
mean diameters of the red corpuscles of various animals, 
and placed in contrast his own measurements with those of 
Gulliver, Prof. Wormley, C. Schmidt (1848), Malinin (1875), 
the Medico-Legal Society of France (1873), Masson (1885), 
Hans Schmid (1878), Woodward (1875), and he has ex- 
tended, in this table, the measurements in fractions of an 
English inch, as also in m.in., or the French millimeter. 
The English inch and its vulgar fraction is in most gen- 
eral use in America, and the French millimeter upon the 
continent. For example, under the French system the 
diameter of the human corpuscle is 0.0079 m.m., equal to 
1-3200 inch of the English system. 
Sometimes the French employ the vulgar fraction of a 
m.m., and sometimes the Americans a decimal of an inch, 
thus: Sometimes expressed in the French system in speak- 
ing of the human corpuscle as 1-120 of an m.m., and in our 
system as 0.0079 m.m., which are equal to 1-3200 of an 
inch. 166 
BLOOD AND BLOOD STAINS 
COMPARATIVE TABLE OF THE AVERAGE RESULTS OF 
MEASUREMENTS OF 
RED 
BLOOD 
CORPUSCLES OF MAMMALS. 
Each column giving the 
average size 
(diameter) of 
the Corpuscles as 
obtained by various 
observers, expressed 
in 
fractions of the English inch, side by side with 
the common expression (roughly) 
in millimeters. 
C- Schmidt, 
French Medico 
Gulliver, 
WoRMLET, 
1848. 
Legal Socie- 
Hans Schmid, 
Woodward, 
Personal Ob* 
1845 and 1875- 
1885. 
Mallinin, 
TT, 1873, AND 
IT! 1 OOU. 
1878. 
1875. 
SERVATI0N6 
1875. 
WlLKER. 
Id. 
M. M.' 
In. 
M. M 
In. 
M. M. 
In. 
M. M. 
In 
M M 
In. 
M. M 
In. 
M. M. 
In. 
M. M. 
1 2745 
0-0092 
1.2738 
0 0093 
1,2769 
0,0088! 
Walrus v. 
1,2769 
0.0088; 
Sloth ..... 
1,2865 
1,anno 
0.0086, 
n no8i 
— 
• -• 
>>)*«• 
Whn.lt. ....... 
P3099 
0i0080 
- 
1.3557 
0 0071 
1 3145 
0 0080 
1.3190 
0.0080 
1.3164 
0 0080 
Man 
1.3200 
0.0079 
1 3250 
0 0078 
1 3300 
0 0077 
1 3257 
0 0078 
1.3257 
6.0078 
1 3412 
6.0074 
1 3092 
0 0082 
1.3200 
0 0079 
Seal 
1 3281 
0 0078 
Beaver. 
. 1.3325 
0.0076 
f» . • • . 
,,, ..... 
• 1 T *1 t 
1 3550 
0,0072 
_ , 
1,3369 
0,0075 
1.3412 
0 0074 
1 3382 
0.0075 
’ 
1.3440 
0*0074 
1 3410 
0 0074 
1,3538 
0,0071 
1.3223 
0.0079 
1.3300 
6 0077 
13213 
0.0079 
l 3400 
0 0075 
Wolf— 
1.3600 
0 0070 
1 3422 
0 0074 
l 3450 
0 0074 
Dog". ..... 
1.3532 
•0.0071 
1.3561 
0 0071 
- 1.3636 
0.0070 
i.3485 
0 0073 
1 3577 
0.0071 
1 3846 
0.0066 
i 3246 
0.0078 
l .3580 
6.0071 
Rabbit- .. 
1.3607 
0.0070 
1.3653 
0 C070 
1.3968 
0.0064 
1 3653 
0 0069 
1 3636 
0.0070 
l 3662 
0.0069 
Ass-..„........ 
L4000 
0,0063 
1.3620 
0 0070 
Rat 
1.3754 
0.0068 
13652 
0 0070 
1 3968 
0.0064 
1 5000 
0.0051 
Bear ....... 
1.3693 
0.0070 
1.3656 
0 0069 
1.3814 
0.0067 
1 3743 
0 0067 
1 5000 
6 0051 
Mule 
1.8760 
0 0067 
Squirrel 
1.4000 
0,0064 
1.4140 
9.0061 
Ox 
1.4267 
0.0060 
1.4219 
o men 
1 4354 
i.42a? 
0 0060 
1.4605 
o^ooiki 
1 42nn 
n no6n 
Pig 
1.4230 
0 0060 
1 4268 
o nose 
1.4098 
0.0062 
1.4098 
6.0062 
1 4250 
n nnnn 
Horse 
1 4600 
0.0055 
1 4243 
0,0059 
1 4464 
n nnsr 
1 4310 
0 0059 
Cat 
1 4404 
0.0058 
1 4372 
0 0058 
1.4545 
0 On 56 
i 4440 
0.0057 
Sheep 
1 5300 
0.9048 
t 4912 
0.0951 
n nn5? 
1 6060 
0.0042 
1 5non 
n.onsi 
Goat. 
1 6366 
0.0040 
1 6189 
0.0041 
i.6369 
0.6646 
1 5525 
0.0046 
1.6100 
0.0042 IN MEDICAL JURISPRUDENCE. 
167 
The micrometry of Gulliver’s tables have been very gener- 
ally accepted as standard, although taken a good many 
years ago and with imperfect instruments. 
His studies extended over thirty years, and embraced 800 
animals. 
The object of his work was a biological study, to prove 
that the blood corpuscle was the most reliable means of the 
classification of species in animals. 
His measurements were made almost half a century ago, 
and he did not claim for them exactness of micrometry, but 
he only claimed for them “ that the relative value of the 
measurements, though probably not unexceptionable, may be 
entitled to more confidence as a fair approximation to the 
truth." 
It is a singular fact that all modern observers recognize 
Gulliver as an authority, and that the researches of our best 
workers have strengthened the general conviction of the re- 
liability of his measurements. He is cited by the standard 
authors as an authority. 
It would be quite impossible for me to re-produce Gulli- 
ver’s tables complete, for want of space. 
I shall re-produce his plate, and with it selections from 
his explanations, as prepared by Prof. Formad, giving Eng- 
lish names to the Latin used by Gulliver, and the diameters 
in the fractions of an English inch Some oversights of the 
engraver, as regards omission of figures on the plate, are 
explained in the text. 
Gulliver’s tables. 
Note ; Explanations of the Figures upon Gulliver’s Plates.— 
The red blood-corpuscles are all done to one and the same scale, repre- 
senting i-iooo of an English inch, and each one of the ten divisions 
i-ioooo of an inch. Vide foot of page. Only corpuscles of the average 
size and regular shapes are given, and they are all magnified to the same 
size, 900 diameters. The descriptive tables explain the plate. PLATE IV. 
Gulliver’s micrometry ©f rod blood corpuscles, all to a uniform scale. 
f. MAN. 
II. quadrumana. 
III. CHEIROPTERA. 
Apyrenema 
Vertebrata. 
PYRENjCMATA. 
of an inch . i . . . . . . » « ■ x 900 
rniirF 
U 
G, Gulliver ad. nat. del. BLOOD AND BLOOD STAINS 
169 
A -VERTEBRATA (See Plate IV ) 
I Homo (Man) 1-3200 
*1. Corpuscles lying flat 
2. The same on edge 
3. Membraneous base of same after removal by water of 
coloring matter ; it shows diminution in diameter on 
account of acquired spherical shape. 
II. Quadrumana (Monkeys.; 
4. Simia troglodytes (Chimpanzee). 1-3412 
5 Ateles ater. (Black faced spider monkey) 1-3602 
6 Lemur anguanensis » 1-4003 
III Cheiropetera (Bats ) 
7 Cynonycteris collaris (fruit bat) « 1-3880 
8. Vespertilio noctula (large bat) 1-4404 
9 Vespertilio pipistrellus (common bat) 1-4324 
IV (beasts of prey. ) 
(p) 10. Sorex tetragonurus(shrew) 1-4671 
(o)ll Ursus labiatus (lipped bear) —1-3728 
(r) 12 Bassaris astuta civet cat) - 1-4033 
(*) 13' Cercoleptes caudivolvulus (kinkajou) 1-4573 
(i) 14 Trichechus rosmarus (walrus) 1-2769 
(u) 15 Canis dingo (dog, Australian) 1-3395 
(w) 16 Mustella zorilla (weasel) 1-4270 
(“) 16 Felis leo (lion) , 1-4322 
(b) 16 Felis leopardus (leopard) 1-4319 
(x) 17 Felis tigris (tiger) 1-4206 
(y) 18 Paradoxurus pallasii (Pallas paradoxure) 1-5485 
(z) 19 Paradoxurus bondar (Bondar paradoxure) 1-5693 
(“) 19 Hyena striata (striped hyena) 1-3735 
V Cetacea (Whales.) 
20. Balaena (boops—whale) ......... 1-3099 
21. Delphinus globiceps (caing—whale) 1-3200 
22. Delphinus phocaena (porpoise)™....... 1-3829 
VI. Pachydermata. 
23. Elephas indicus (elephant)...— . ... 1-2745 
24. Rhinoceros indicus (rhinoceros),. - 1-3765 
25. Tapirus indicus (tapir).........— ... 1-4000 
26. Equus caballus (horse).. 1-4600 
27. Dicotyles torquatus 1-4490 
28. Hyrax capensis (Cape hyrax) 1-3308 
VII. Ruminantia (Ruminants.) 
(») 29. Tragulus javanicus, (Javan chevrotain, musk 
deer) 1-12325 
rough an oversight, some of the figures are not marked upon the plate. 170 
BLOOD AND BLOOD STAINS 
) 30 Tragulus nieminna (Indian chevrotain) 1-12325 
(-)31. Tragulus Stanleyanus (Stanleyan chevrotain) 1-10825 
( | 32 Cervus nemorivagus (deer) 1-7060 
(e) 33. Capra Caucasica (Caucasian ibex) 1-7045 
(r)34. Capra hircus(domesticgoat) 1-6366 
(g) 35 Bos urus (represented by Chillingham cattle).. 1-4267 
(b) 36 Camelopardalis giraffa (giraffe). 1-4571 
(i) 37 Auchema vicugna (vicuna) j Sh. D 1-6587 
!t it) 1*—3^61 
Sh D 1-6229 
0)39 Auchenia glama (llama) j ll(j229 
(m) 40 Camelus droraedarius (single hump) L. D. 1-3254 
cameL ( Sh. D. 1-6931 
(„) 41 Camelus bactrianus (double hump(L. D. 1-3123 
camel) >./|Sh. D. 1-5876 
(") 42. Cervus Mexicanus* (deer—Mexican).. 1-5175 
VIII. Rodentia (Rodents). 
43. Hydrochcerus capybara (capybara) 1-3190 
44. Castor fiber (beaver) 1-3325 
45 Sciurus cinereus (squirrel) 1-4000 
46 Mus messorius (harvest mouse). 1-4268 
IX Edentata 
47. Myrmecophaba jubata (ant eater) 1-2769 
48 Bradypus didactylus (sloth).. 1-2865 
49. Dasypus villa (armadillo) 1-3315 
X Marsupialia 
50 Phascolomys (wombat) 1-3456 
51. Hypsiprymnus setosus (kangaroo rat) 1-4000 
XI Monotremata 
52 Echidna histrix (echidua) 1-3840 
B -vertebrata 
XII Aves (Birds) L D Sh D 
1. Struthio camelus (ostrich) 1-1649—1-3000 
2 The same made round and deprived of 
color by water 
3 Vanga destructor (East India shrike) 1-2019—1-3892 
4 Lanius excubitor (great grey shrike) 1-1989—1-5325 
5 Bubo i£irginianu8 (horned owl) 1-1837—1-4000 
6 Syrnea1 nyctea (snowy owl) 1-1555—1-4042 
7 Columba rufina (rufous pigeon) 1-2314—1-3329 
8. Columba migratoria (wild pigeon) 1-1909—1-4626 
9 Dolichonyx oryzivorus (rice bird) 1-2400—1-4167 
* The only animal In which the red blood corpuscles present a variety of shapes In 
the same Individual —Gulliver IN MEDICAL JURISPRUDENCE. 
171 
10 Buceros rhinoceros (rhinoceros hornbill)... 1-1690—1-3230 
11. Psittacus augustus (August amazon) 1-2085—1-3606 
12. Phasianus superbus (barrel-tailed pheasant) 1-2128—1-3587 
13 Pelecanus onocrotalus (white pelican)..... 1-1777—1-3369 
14 Trochilussp (hummingbird) 1-2560—1-4000 
Figures XII . XIV , XVI . XVII and XVIII represent red blood 
corpuscles of Reptilia and Bactrach a; while under figure XIX. 
those of the fishes are given In all these figures the names of the 
animals are inserted upon the plate, and they do not require any 
comment at this place It is evident that the blood corpuscles of 
the Amphiuma are so large that they can be perceived by the 
naked eye. 
welcker’s tables. 
The measurements by Welcker are of very exact measure- 
ments of certain animals, and I am enabled to give the 
following table of a few of his mean measurements. 
For man, on an average, expressed in millimeters: 
Min. Max. 
Diameter of disc, 0.00774, - 0.00640 0.00860 
Greatest thickness of the disc, 0.00190 
These measurements were made on fresh blood or blood dried in thin 
layers on glass. 
His mean table is as follows: (Zeitschrift fur rationelle Medecin, 3 R. 
Band, * * p. 259; Strieker’s Manual of Histotomy, article “Blood,” 
by Alex. Rollett, p. 267, et seq.) 
I. Circular Corpuscles. 
Dog 0 0073 
Cat -. 0 0065 
Rabbit 0 0069 
Sheep 0 0050 
Goat (old) 0 0041 
Goat (8th day) 0 0054 
Moscbus Javanicus 0 0025 
Petromyzon mari 0 0150 
Ammocoet branch 0 0117 
II. Elliptical Corpuscles. 
a, Long diameter ; b, short diameter. > 
a. b 
Lama 0 0080 0 0040 
Pigeon (old) 0 0147 0 0065 
Pigeon (fledged) 0 0137 0 0078 
Pigeon (fledged) 0 0126 0 0078 
Duck 0 0129 0 0080 
Fowl ...00121 0 0072 
Rana temporana 0 0223 0'0157 
Rana temp, (dry) 0.0214 0 0156 
Triton Cristatus 0 0293 0 0195 
Proteus (1 and 2) j 0 0579 0 0356 
Sturgeon 0 0134 0 0104 
Cyprinus Album 0 0131 0 0080 
Lepidosiren Annecteus 0 0410 0 0290 172 
BLOOD *AND BLOOD STAINS 
The method employed by Welcker has been thus des- 
cribed : 
He employed a very short cylinder of plaster of Paris, the proportion 
of the radius to the height of which was estimated to correspond with the 
dimensions of the blood corpuscles; and by scooping out the surface and 
rounding off the edge he obtained a curvature of the surface which, to the 
eye,( !) was similar to that of the blood corpuscles. He thus determined 
the mean volume of human blood red corpuscles to be .000.000.072,217 of 
a cubic millimeter. Welcker, moreover, carefully linedithe interior of this 
model, which was 5,000 times larger than the corpuscles, with paper of 
uniform thickness, then weighed the paper used and compared this with 
the weight of a known superficial measure of the same paper. From the 
data thus obtained he estimated that the superficies presented by a blood 
corpuscle amounts to 0.0,001.280 square millimeters. It is sufficiently 
obvious that these numbers have only a coarsely approximate value.” 
The most extended tables of the measurement of corpus- 
cles are to be found in Milne Edwards. (Lecons sur la Pliy- 
siologie et 1’ Anatomie Comparie, Paris, 1857, T. 1 p. 41. 
FROF. WORMLEY’s TABLES. 
The following tables of the average or mean size of the 
normal red blood-corpuscles of different animals were made 
by Prof. Theo. G. Wormley, in general from blood after the 
corpuscles had been dried in very thin layers, but in some 
instances while the blood was still fluid, and is taken, by his 
permission, from his work, “ Micro-Chemistry of Poisons,” 
published by J. B. Lippencott & Co., Philadelphia, in 1885. 
These averages he has expressed in vulgar fractions of an 
English inch, and are the mean of two or more series of 
measurements, and in some instances of the blood of differ- 
ent individuals of the same species. 
Prof. Wormley has contrasted his measurements with those 
of Prof. Gulliver, as published in the proceedings of the 
Zoological Society of London, June 15, 1875, and also in 
Hewson’s works, at page 237, et seq. IN MEDICAL JURISPRUDENCE. 
173 
COLLECTIVE RESULTS OF SOME OF THE SERIES OF MEASUREMENTS OF RED BLOOD 
CORPUSCLES IN BLOOD STAINS AND IN EXPERIMENTALLY DRIED BLOOD 
Normally shaped (bi-concave, disc-like) corpuscles only being measured. 
Source of Blood. 
Upon what 
Substance 
Age of Stain. 
Condition, or how 
Prepared* 
Number oi Indi- 
viduals Exam- 
ined. 
Number of Pre- 
paratlons 
Made. 
Reagents used 
for Remoisten- 
ing, 
Time of effect of 
Reagents. 
Percent, of Meas- 
urable Corpus- 
oles in eaoh 
preparation. 
Total Number of 
Corpuscles 
measured. 
Average Diame- 
ter in inch. 
Normal Diame- 
ter of Fresh 
Blood. 
10 
30 
*K n h 
2 
10 
K O. H- 
1VJVJU 
4 
20 
«1ff. F 
1 
Mao. .*« 
Paper . - 
14 days. 
Decomposed from moisture. 
i 
10 
M. F. 
3 days. 
not me 
asurabl 
e. 
Knife 
1 
10 
K.O H.AM F 
i 
30 
K. O. H. & M. F 
500 
1-3320 
6 
18 
K.O. H. 4M.F 
10 to 4/1 
V 
500 
1-3400 
1-3400 
Wolf 
Rapidly dried stains 
1 
50 
K.O.H.& M. F. 
1 to 2 days. 
5 to 20 
1600 
1-3450 
1-3450 
Cloth ........ 
4 
12 
K.O.H.& M. F. 
5 to sn 
50(1 
1-3050 
1-3580 
Knife 
10 
30 
K.O. H. A M. F. 
5 to 50 
1000 
1-3700 
1-3602 
Ox 
10 
30 
K. O.H. AM. F 
20 to 40 
moo 
1-4240 
1-4200 
Sheep 
Glass 
7 days. 
Rapidly dried stains......... 
3 
9 
K.0.H.4 M.F. 
1 to 2 days. 
60 
500 
1-5060 
1-5000 
Goat 
Knife 
7 days. 
Rapidly dried stains.... 
3 
9 
K.O.H.&M.F. 
1 to 2 days. 
50 
500 
1-6200 
1-6100 
* «< 
K. 0. H." 
stands for 33 per cent. Solution of C&ustic Potash. “ M. F.” for Muller’s fluid 174 
BLOOD AND BLOOD STAINS 
It will be observed, on a scrutiny of these tables, that 
there is a marked difference between these observers in the 
diameter of the corpuscles of the opossum, amounting to 
l-27152d of an inch, and a similar discrepancy in those of 
the guinea-pig. 
Prof. Formad challenges the correctness of Prof. Worm- 
ley’s measurements and those of Dr. Woodward (1.3213). 
Prof. Formad says (Comparative Studies of Mammalian 
Blood, p. 18), that he examined ten different animals, mak- 
ing ten preparations in each case, and measuring 100 cor- 
puscles from each animal, and found that the mean diameter 
was 1-3400 of an inch in every 1,000 corpuscles. 
His results were confirmed by Drs. J. L. Hatch, A. J. 
Plumer, and Henry Wile, and by the celebrated Dr. Rich- 
ardson, and they approximate nearer those of Gulliver. 
Dr. Formad also says that Wormley’s observations were of 
the corpuscles of one wild guinea-pig (cavia aperia), while 
Formad’s examination was of the domestic (cavia cobay a), 
and that while Woodward’s measurements were of the blood 
of the latter animal, that his micrometry wras unreliable, in 
that he only examined 401 corpuscles, all from one drop of 
blood, and from a single individual. 
I take pleasure, also, in quoting Prof. Wormley’s observa- 
tions of old blood stains, from his “ Micrometry of Poisons,” 
with his table and explanatory marks. IN MEDICAL JURISPRUDENCE. 
175 
Examination of Old Blood-Stains. 
ANIMALj. 
Age of Stain., 
Remarks. 
Average. 
Fresh Blood. 
(1) Human . . 
2 months old. 
Stain, unknown. 
1—3358th inoh. 
1—3250th inch. 
(2) “ • • 
24 “ 
3 “ 
Stain. 
1-3236th “ 
C <| 
(3) “ . . 
<< 
1—3384th " 
a n 
(4) “ . . 
19 “ “ 
Clot. 
1-3290th “ 
a u 
(5) Elephant . 
13 “ 
<< 
1—2849th “ 
1—2738th “ 
(6) Hog . . . 
4 <<* << 
Trace of stain, 
unknown. 
l-3626tb “ 
l-3561st “ 
(7) Rabbit . . 
18 “ “ 
Clot. 
1—3683d “ 
1—3653d 
(8) Ox ... . 
16 “ “ 
Stain. 
l-4544th “ 
1-4219th “ 
(9) “ . . . . 
32 “ “ 
Stain, unknown. 
l—4495th “ 
« it 
(JO) “ . . . . 
4i years “ 
Clot. 
1-4536th “ 
U (i 
1—4351at “ 
(11) Buffalo . . 
18 months" 
1—4312th “ 
(12) Goat . . . 
17 “ “ 
Stain. 
l-5897th “ 
1-6189th '• 
(13) Ibex . . . 
IS “ 
Clot. 
1-6578th “ 
1—6445th “ 
In the case of the human blood, No. 1, two months old, the deposit was in the form of a 
thin stain on muslin, and its nature, other than that it wa3 blood, was unknown 
at the time of examination. The corpuscles were readily found, and two series of thirty 
corpuscles each were measured. In the human blood two and a half months old, fifty 
corpuscles, ranging from l-3125th to l-3448th of an inch, were measured. 
The blood-stain of the dog, No. 6, was prepared by Dr. Frankenberg, and consisted of 
a single stain so minute ns to be barely visible to the naked eye: its nature at the time ut 
the examination was unknown. In this instance only fifteen corpuscles were measured. 
In the ox blood four and half years old, the corpusoles were rather readily obtained, 
and two closely ooncordant series of measurements were made, 
In examinations of this kind it should be borne in mind that certain portions of a 
deposit may fail to yield satisfactory results, whilst from other portions the corpusoles may 
be readily obtained. 
NUMBER OF THE RED-CORrUSCLES. 
The actual number of the red corpuscles have been 
counted with the greatest exactness by the aid of the micro- 
scope. The method employed is very simple : 
A given quantity of blood is diffused as equably as possible in a thousand 
times its volume of an indifferent fluid, say water. A small quantity of 
the fluid is then taken up in a capillary tube of known caliber, and the 
length of the thread of fluid estimated under the microscope by a microm- 
eter. 
When the contents of the tubule have been thus ascertained, they are dis- 
tributed upon a slide with a little solution of gum and allowed to dry. 
This preparation is then covered with a micrometer divided into squares, 
and the corpuscles in the several squares can be successively counted. 
This method originated with Vierordt.—(Archiv fur Physal. Hiel Kunde 
Band xi pp. 2G, 327, 854. xiii p. 259.) 
It has also been modified by Welker, who has counted the blood corpuscles 
of man and of various animals.—(Welker Prager Viertelgahreschrift Band 
xliv, p. 60. I. R. Band xx, p. 280.) 176 
BLOOD AND BLOOD STAINS 
The number of red corpuscles in a cubic millimetre of 
blood of a healthy man is thus determined to be about 5,000,- 
000, from which the number in a gallon, quart, pint, or ounce 
can be computed. 
It has also been as clearly demonstrated that the relative 
quantity of corpuscles and plasma or serum (liquor san- 
guinis) in a hundred volumes of blood is thirty-six volumes 
of corpuscles and sixty-four volumes of plasma. Thus 
the volume of blood is 64-100ths plasma or serum and 
36-100tlis corpuscles. (See Prof. Strieker’s Manual of Histo- 
logy, Article Blood, by Alexander Rollett, translated by 
Henry PoAver, of London, Chap. 13, p. 269.) 
VARIATIONS IN SIZE OF THE RED CORPUSCLE. 
Prof. Ewell lias shown by experiments that many diseases 
alter the size of the corpuscles, especially microcythaemia, 
and that they also vary in health. 
I have submitted, with his permission, three tables (I, II, 
and III), showing the result of the measurement of 650 cor- 
puscles of the fresh blood of Prof. Ewell, then being in good 
health. 
These diagrams were first drawn in rectangular co-ordi- 
nates. 
The horizontal divisions, unless otherwise noted, represent 
each one division of the eye piece micrometer. The vertical 
divisions represent the number of corpuscles, each division, 
unless otherwise noted, representing one corpuscle. The 
point of origin at the left is for want of space not shown on 
the diagrams. The curved lines, representing the number of 
corpuscles, are drawn with the point of origin as their com- 
mon center, and Avitli radii equaling the number of divisions 
of the micrometer subtended by them respectively. The 
curves, therefore, represent on a large scale the relative size 
of the corpuscles. IN MEDICAL JURISPRUDENCE. 
177 
Six hundred ard fifty corpuscles from M. D. Ewell. Spnecer r-ioar.d Bausch & Lcmb Amplifn r. i div. of filar micrometer=.ooocoi inch 
Mean of ist roo =.000322 =8.18 mikrons. Mean of 6th 100 =.000318 =8.05 “ 
“ 2d “ =.000324 =8.23 “ “ last 50 ....=.000313 =7.95 “ 
“ 3d “ =.000321 =8.15 “ “ 650 corpuscles (corrected) .000316 =8.03 “ 
“ 4th “ =.000315 =8.99 “ Largest corpuscles of the 650 =.000393 =9.98 “ 
“ 5th “ =.000316 =8.03 “ Smallest “ “ “ =.000198 =5.03 “ 
Each vertical space=one corpuscle, except in case of the last 50, where two spaces=i corpuscle. 
Each horizontal double space=io divisions of the micrometer. 178 
BLOOD AND BLOOD STAINS 
No. II. The first 600 corpuscles of the 650 platted in No. I. Spencer t-10, etc. 
1st 200 mean —.000323 inch =8.20 mihrons. 
2d “ —.000318 “ =8.01 “ 
3d “ =.000317 “ =8.05 “ 
Each space divisons of the micrometer. 
Each space vertically=i corpuscle. IN MEDICAL JURISPRUDENCE. 
179 
No. III. The same 600 red corpuscles. Spencer i-ro, etc. 
1st 300 mean =.000322 inch =8.18 
2d “ =.000316 “ =8.01 
600 mean =.000319 “ =8.10 
Each horizontal space=5 divisions of the micrometer. 
Each vertical space=2 corpuscles. 180 
BLOOD AND BLOOD STAINS 
We are not aware that this knowledge has thus far been 
of the slighest use in medico-legal investigation, but it may 
become so, as the histological studies of blood by this author 
are of the greatest value. 
I shall conclude this short paper with a few replies re- 
ceived from scientists to whom I wrote for their views upon 
the question of whether there was any means, now known to 
science, to enable the observer, by the microscope or in any 
other manner, to distinguish between the blood of man and 
the domestic animals, and notably those mammalia whose 
red corpuscles approximate nearest to those found in human 
blood. 
Prof. Marshall Ewell, President of the American Micro- 
scopical Society, replied as follows : 
Canton, O., May 4, 1892. 
My Dear Sir I had occasion, as an expert in the celebrated case of the 
murder of Dr. Cronin, to examine the question proposed for discussion, and 
came to the conclusion, which I have since seen no reason for modifying, that 
it is impossible by any means at present known to science to discriminate be- 
tween dried human blood and that of the dog, rabbit, guinea-pig, or of any 
other domestic animal. My reasons for this opinion are given at length in 
a paper entitled “ A Micrometric Study of 4,000 Red Blood Corpuscles in 
Health and Disease,” a copy of which I have contributed to the Medico- 
Legal Society, and which is published in No. 2, Yol. 10, Medico Legal 
Journal. 
My experience in the subject of microscopy, in which I have specialized 
for the last eight years, leads me to the conclusion that there is not only no 
advantage in the use of very high powers (1-25 or 1-50), but a positive dis- 
advantage, if the power is so high as to impair the definition, as appears to 
have been the case in the work recorded in the monograph of Dr. Formad, 
judging from his published engravings. Dr. Formad, of Philadelphia, in 
that paper, appears to me to have misquoted authorities to such an extent 
as to lead me to repose no confidence whatever in his published results. 
I know of no new advance in science in relation to the identification of 
blood stains since the publication of my paper above referred to. 
Respectfully yours, 
M. D. EWELL. 
Dr. Bobert Keyburn, of Washington, D. C., Vice-President 
American Microscopical Society, was present and took part 
in the discussion of the paper. He said: IN MEDICAL JURISPRUDENCE. 
181 
The question of the method of distinguishing between the blood cor- 
puscles of man and the ordinary domestic animals is one of great forensic 
importance, and has also been one of the most vexed questions in micro- 
scopical science. 
The human red blood corpuscle, or cell, as is well known, is a circular 
disc, which is bi-concave, or hollowed inwards, on both its surfaces. 
When seen singly they are of a yellow hue, though in quantity, as seen in 
the arterial blood, they are of a scarlet red color. 
We have also existing in blood the white corpuscles, which are slightly 
larger than the red, being 10 to 12 microns, or 1-2750 to 1-3000 of an inch in 
diameter, and also the blood plates, or tablets of Bizzozero, which are 
from 2 to 3 microns, or 1-8000 of an inch in diameter, one-third the 
size of the red corpuscles ; however as these component parts of the blood 
do not offer any satisfactory means of identification in blood stains, or 
clots, it will not be necessary to dwell farther upon them. 
The human red blood corpuscle varies for 7.9 microns, or 1-3200 of an 
inch, to 6.9 microns, 1-3500 of an inch, in diameter, and are about one- 
fourth that in thickness (or 1 910.) 
The variation in size of the corpuscles will rarely vary more than from 
10 to 12 per cent, of the number of any blood corpuscles in any specimen of 
human blood. Examined we will find from 80 to 90 per cent, of the num- 
ber of human corpuscles present of the average size, viz : 1-3200 to 1-3500 
of an inch. 
Dr. Formad, in his Monograph (Comparative Studies of Mammalian 
Blood), gives the following coparative measurements of blood corpuscles : 
Man, 1-3200 of an inch ; guinea pig, 1-3400 of an inch ; wolf, 1-3450 of an 
inch; dog, 1-3580 of an inch; rabbit, 1-3662 of an inch; ox, 1-4200 of an 
inch; pig, 1-4250 of an inch; horse, 1 4310 of an inch; sheep, 1-5000 of an 
inch; goat, 1-6100 of an inch. 
After giving these various dimensions of the blood corpuscles of different 
animals, the question naturally arises: Where is the difficulty in measuring 
these ? Can we not, by the accurate micrometers and microscopes we now 
possess, measure them just as accurately as the carpenter measures any 
square surface by the use of a rule or tape measure ? This, however, is not 
the real difficulty. Our instruments of precision are amply capable of 
meeting the exigencies of the case, but the difficulty lies in an entirely dif- 
ferent direction. 
The trouble in our investigation of this subject lies in the fact that the 
blood corpuscles are living organisms that are not possessed of outlines 
delineated with mathematical accuracy. 
They vary in the same animal, and in different species of the same ani- 
mal, to such a degree as to greatly impair the accuracy of the deductions to 
be drawn from even the most accurate series of measurements. 
Dr. J. G. Richardson, in papers published in American Journal of Medi- 
cal Sciences, July, 1869, page 50, and July, 1874, page 102, states, as the 
result of his investigation, that he could invariably distinguish between the 
dried blood corpuscles of the man and the sheep when so situated that he 
could not know from what source they were derived. 182 
BLOOD AND BLOOD STAINS 
He states (page 106 A. J. M. Sciences, July, 1874, or the 16th May, 1874,) 
my friends, Prof. J. J. Reese and D. S. Weir Mitchell, prepared for me 
these three packages of dried blood, from stains made by sprinkling the 
fresh fluid (blood) from an ox, a man, and a sheep on white paper. 
These stained pieces of paper were numbered 1, 2, and 3, respectively, 
and given to Dr. Richardson to examine, and he succeeded perfectly in 
distinguishing the source from which they came by the use of the micro- 
scope. 
Dr. J. J. Woodward (A. J. M. Sc. Jan., 1875, p. 151,) controverts the 
arguments of Dr. J. G. Richardson, and states that he believes it to be im- 
possible to distinguish between the blood corpuscles of man and several of 
the domestic animals ; though he confines his argument more especially to 
the similarity in size of the blood corpuscles of the dog to those of man. 
He states (p. 158) that on making each measurement of blood containing 
50 corpuscles from as many men their sizes ranged from 7.72 microns to 
7.54 microns. 
He compared these measurements with nine specimens of blood of dif- 
ferent species of dogs, measuring 50 corpuscles each time, and found their 
sizes to range from 7.42 microns to 7.37 microns. 
These measurements are so nearly alike that they seem to be practically 
identical, and the known accuracy and skill of Dr. Woodward gives his 
opinion great weight. 
He further says, (p. 156,) ‘ ‘ For myself, after repeated measurements of the 
blood of the dog and human blood, I can only say that I find no constant 
difference between them, whether the fresh blood or thin layers dried on 
glass be selected for measurement.” 
The mean of 50 corpuscles taken at hazard is seldom twice the same, and 
sometimes that of human blood, sometimes that of dog’s blood, is a trifle the 
largest. 
In his Monograph, Comparative Studies of Mammalian Blood (p. 19 and 
47), Dr. Henry F. Formad has shown, however, that the measurements 
given by Dr. Woodward were erroneous and misleading, and would not now 
be accepted by any haematologist of the present day. 
Dr. Alexander Eddington, in a paper published in the British Medical 
Journal, 1890, (p. 1233,) gives an interesting account of the present state of 
our knowledge regarding the blood, and gives his own observations upon 
the subject. He shows the very varying sizes of the human red blood cells 
and the readiness with which this variation takes place. 
There is namely a distinct variation in the aggregate size between meals, 
the minimum occurring soon after a meal, while the maximum is seen at 
the end of a period of fasting. He also states the red blood corpuscles are 
diminished in size at the termination of an acute fever, after an exanthe- 
matous disease (such as scarlet fever or measles), while they are the largest 
during the fever. They are small in septic conditions, such as pyemia and 
erysipilas, which have lasted some time. 
F. Detmers (Proceedings of American Society of Microscopists, 1887, p. 
216,) has given a valuable series of measurements of blood corpuscles, from 
which I extract the following, (Ibid, p. 219): ‘ ‘ After carefully examining 
the specimens of blood I can assert, without fear of contradiction, that 183 
IN MEDICAL JURISPRUDENCE. 
there can be no question hut the blood of human beings can be readily dis- 
tinguished from that of such animals as the mule, cat, calf, horse, etc., and 
still more readily from cattle, sheep, and pigs.” 
Dr. Formad (Ibid, p. 20) calls attention to the great value of photo- 
graphs taken of blood corpuscles under very high magnifying power, such 
as ten thousand diameters. Under such magnification the differences be- 
tween the differences in sizes between those of man, dog, ox, sheep, and 
goat, become readily distinguishable by the naked eye. 
The following seems to me to represent the present state of our knowl- 
edge of blood stains from other stains with which we might be con- 
founded : 
1. Blood stains can be certainly and absolutely differentiated from stains 
produced by other colored fluids, by the presence or absence of the red 
blood corpuscles. 
2. The blood corpuscles of birds, fishes, and reptiles, being oval and 
nucleated, can never be mistaken for those of human blood. 
3. If the average diameter of the blood corpuscle in any specimen of blood 
(containing at least one hundred, and better five hundred corpuscles,) is 
less than 1-4000 of an inch, it cannot possibly be human blood. 
4. If the blood corpuscles have an average diameter of from 1-3200 to 
1-3300 of an inch, then it is human blood, (excluding the blood of the beaver, 
guinea pig, kangaroo, monkey, muskrat, porcupine, seal, or wolf.) None 
of these are domestic animals, and stains produced by their blood can 
scarcely ever be met with under such circumstances as to be confounded 
with stains of human blood. 
5. The blood corpuscles of the dog 1-3580, rabbit 1-3062, ox 1-4200, pig 
1-4250, horse 1-4310, sheep 1-5000, goat 1-6100, can, by the use of high 
magnifying power, and the careful counting of 100 to 500 corpuscles, be 
differentiated from human blood corpuscles, both in recently shed blood 
and dry blood stains. 
The late gifted Prof. Henry F. Formad replied under date 
of May 9, 1892, upon the subject, as follows : 
3535 Locust St., Philadelphia, Pa., 5-9-’92. 
Clark Bell, Esq. : 
My Dear Sir:—I have written lately on blood and blood stains, but cannot 
lay my hands just now on these recent publications. I send you with this 
mail a copy of one of my monographs on blood and blood stains, which is 
the most complete one on the subject written either by myself or anyone 
else of late years. From the perusal of this monograph you will glean to 
your satisfaction what is known to the present day upon this intricate sub- 
ject. 
Nothing new has been done on blood stains since the writing of this 
article. 
Our methods of investigating blood are, however, improving step by step 
with the improvement of the microscope and the modern appliances of 
the same. What was impossible to do ten or twenty years ago, viz : the 
distinction between the different size of corpuscles, is at present a compar- 
atively easy matter. The older statements that human blood cannot be 184 
BLOOD AND BLOOD STAINS 
distinguished, even in its dried state, from that of the ordinary domestic 
animals, is erroneous. 
There is difficulty of telling human blood from that of the guinea pig, 
opossum, dog, rabbit, or monkey, and certain wild animals, but there is no 
difficulty at all of discriminating the blood of the “ ox ” species, pig, horse, 
sheep, goat (even in its dried state), from that of man, on account of the 
musch smaller measurements of the blood corpuscles. * * * 
I will say, in conclusion, that whereas it is impossible to say with certainty 
that any given blood stain, new or old, is due to human blood, it is quite 
possible to state that it is the blood of a mammal, and that it is consistent 
with human blood, and that it is not the blood of certain domestic animals. 
For details about this question I must refer you to my monograph, now in 
your hands. I much regret I will be unable to be present at the reading of 
your paper on this subject, but I hope to see it in print. 
Dr. R. J. Nunn, of Savannah, Ga., an experienced obser- 
ver, and one of the Vice-Presidents of the American Micro- 
scopic Society, replied as follows : 
119 York St., Savannah, Ga., May 9, 1892. 
Ci.ark Bkll, Esq., 
President Medico-Legal Soc., 
57 Broadway, N. Y., 
Dear Sir:—Of the possibility of distinguishing between the blood of 
animals and of man, I have not the least doubt, but that it is always suc- 
cessfully done I very much doubt; nor do I think that the differenitation 
should be built upon one characteristic alone, and, further, it will require 
special training and enormous practice, to reduce the observation to any- 
thing like certainty. 
In a medico-legal aspect, I think such observations should only be regarded 
as confirmatory, as should be the case with all delicate scientific investiga- 
tions. The improved scientific observations of to-day too often refute the 
certainties of yesterday, and remove them from the domain of positive 
evidence. 
Dr. Ira Van Giesen, of the Pathological Laboratory of the 
N. Y. College of Physicians and Surgeons, N. Y. City, a very 
careful student of the science, replied as follows : (He was 
present at the session and took part in the debate.) 
I have always felt wholly unable to distinguish dried up human blood 
from the domestic mammalia-with the microscope, simply because the red 
blood cells swell up so irregularly that measurements are unreliable. Nor 
do I know of any other way of settling this question. 
I shall endeavor to be present at the meeting of May 11th, and thank you 
for your kind invitation to the same. 
Dr. F. W. Draper, of Boston, an experienced observer, 
replied as follows : IN MEDICAL JURISPRUDENCE. 
185 
My opinions on the subject of the value of expert testimony concerning 
the identification of human blood stains cannot be better expressed in a few 
words than by making use of a quotation from Formad’s valuable mon- 
ograph. He writes, after full discussion of the views of various author- 
ities : “If the testimony is, as customarily, worded : ‘The blood is con- 
sistent with human blood,” it is usually quite satisfactory to the prosecution, 
and is an expression sufficiently guarded.” Beyond this point, I do not think 
science is at present prepared to go. 
Prof. Wormley, of the University of Pennsylvania, replied 
as follows : 
Philadelphia, May 6, 1892. 
Clark Bell, Esq. ; 
Dear Sir:—In reply to your kind invitation, it would give me much 
pleasure to hear your paper on “ Blood and Blood Stains,” on the 11th inst., 
but a previous engagement will prevent my being present. 
The results of my own investigations upon this important subject are so 
fully expressed in my article upon this subject in the Micro-Chemistry of 
Poisons, that I have nothing special to add. 
I am, very truly yours, 
THEO. G. WORMLEY. 
Dr. Charles Heitzman, of New York, an experienced mi- 
croscopist, replied as follows : 
My experience is limited to the blood of the ox and the dog, as compared 
with human blood, especially also in a dry condition. As to their dis- 
crimination, the results of my observation are negative, viz : I would be 
unable to positively tell a difference between the blood corpuscles of man 
and the named animals. 
Thanks for your kind invitation, but my evenings are taken up by labra- 
tory work, and I could not promise to be present. 
MICROMETRY. 
The most important factor in accurately determining the 
exact measurements of the diameters of blood corpuscles is 
the micrometer. 
It is not from the microscope or its teachings that differ- 
ences have arisen, and concerning which divergences of 
views occur among observers. 
It must be considered and remembered that the claims of 
discrimination as to the size of the red blood corpuscle in 
the various animals rests upon the accurracy and reliability 
of the measurement of mean diameters. 186 
BLOOD AND BLOOD STAINS 
A brief statement of the methods employed in reaching 
the results that have been generally accepted as standard 
and reliable mean measurements will throw light upon the 
subject, and at the same time illustrate the views of those 
who differ so widely as to the reliability of attainable results. 
The methods employed by observers must have great weight 
in determining the value and accuracy of results. 
formad’s method. 
Place a drop of blood upon a slide, and quickly draw the 
edge of another slide across the field in such a manner 
that the corpuscles become as evenly distributed as possible 
between the slides. 
Then use a good microscope, provided with a homogen- 
eous immersion lens, and two micrometers, the one a stage 
piece, the other an eye piece micrometer. 
The stage micrometer is used to establish the correct value 
of the lines ruled on the micrometer, and consists of a glass 
slide ruled to a scale either in M. M. or fractions of an inch. 
The English standard slides are ruled by a series of lines 
1-100 of an inch apart, one of these divisions having further 
subdivisions into thousandths of an inch, and in some still 
smaller subdivisions. 
Of course all depends upon the absolute correctness of 
these rulings, and they should be carefully tested before 
using. 
The safest way is to use a high power compare one 
division with another carefully, and note the discrepancies, 
using only such as are exact and precisely correct. The eye 
piece micrometer is a slip of glass with fine lines ruled to a 
uniform scale, which fits into the eye piece of the micro- 
scope. 
When in position the stage micrometer notes how many 
of the divisions on the eye piece micrometer are required to 187 
IN MEDICAL JURISPRUDENCE. 
fill one of the divisions of the stage micrometer; for exam- 
ple, if a 1-12 Zeis’s hom mer lens is used, and under this 
amplification, the l-000th of an inch division of the stage 
and scale covers exactly twenty places in the eye piece 
scale, then each division of the eye piece micrometer will be 
equal to the l-20000th of an inch. 
The higher objectives will increase the value of the divi- 
sions ; lower ones will decrease them, but that under all cir- 
cumstances the same conditions must be observed. 
When thus adjusted, bring the slide containing the drop 
of blood into focus under the eye piece micrometer, pre- 
viously adjusted, and observe the number of division or frac- 
tions of a division of the eye piece micrometer that a cor- 
puscle may occupy. 
For example, if it should fill exactly four spaces, then its 
value would be under l-20000th of an inch. Standard 
4-20000 or 1-5000 of an inch. 
Measure one hundred corpuscles in this manner, taking 
actual measurements and noting them, and from different 
slides that have been tested, and then take an average of the 
result. The measurements should be made only of perfectly 
round bi-concave corpuscles, and carefully recorded. All 
small or crenated blood corpuscles should not be counted. 
Dr. Carl Seiler, of Philadelphia, introduced the micrometry 
of blood corpuscles from photographic negatives, which has 
also been done by Dr. Woodward, of U. S. N. 
The plan is to mount the blood directly upon a glass stage 
micrometer and to photograph them with any desired ampli- 
fication, both blood and micrometer appearing sharply de- 
fined in the picture. The measurements are then made 
directly upon the negative.—(Formad’s Comparative Studies 
of Mammalian Blood, pp. 7 and 8.) 188 
BLOOD AND BLOOD STAINS 
PROF. EWELL’S METHOD. 
Prof. Ewell is the President of the American Society of 
microscopists, and he kindly furnished me with his method of 
making microsmetric measurements. 
He says: “ The first requisite, of course, in making meas- 
urements of a microscopic object, is a correct standard of 
length; which may be either the 1-1000th or some other 
minute fraction of an inch, or 
the one l-100th or other fraction 
of a millimeter. 
The corrections of the stand- 
ard used should of course be 
ascertained. 
We will assume that the 
standard used is the 1-1000th 
part of an inch, and when viewed 
under the microscope the image 
appeared to be as shown in 
Fig A. 
In the eye piece of the microscope is another scale, ruled 
to any convenient fraction of 
an inch, say to the 1-lOOOtli 
paid of an inch, with the fifth 
and tenth line longer. Vide 
Fig. B. 
On looking through the 
microscope at the l-1000th 
of an inch on the stage, we see 
projected upon it, in the same 
field, the image of the lines 
ruled upon the glass circle in 
the eye piece. Vide Fig. C. 
We will suppose that twenty spaces of the eye piece IN MEDICAL JURISPRUDENCE. 
189 
micrometer exactly coincide with the terminal lines of the 
1-1000 of an inch, as shown in the figure C. 
We then know that each one of the finer divisions of the 
eye piece micrometer represents 
a length equal to the l-20tli of 
l-1000th of an inch, or the 
l-20000tli of an inch. Now 
suppose the stage micrometer 
to be removed, and any micro- 
scopic object, as for example a 
blood corpuscle, the diameter 
of which we wish to measure, 
to be substituted in its place, 
and to appear to subtend five 
divisions of the eye piece micrometer, as shown in Fig. D. 
We then know that the diameter of the blood corpuscle is 
5-20tlis of an inch, or the 
l-4000tli part of an inch. 
v 
This is the simplest manner, 
and I may add a very reliable 
manner, when used with high 
powers, of making micrometric 
measurements. 
My experience shows, that 
with very high powers, substan- 
tially the same results can be 
obtained in this manner as by 
the use of the most elaborate means, namely: The filar 
micrometer, which consists of a cob-web moved across the 
field in the focus of the eye piece, by a very fine screw, with 
an index head divided into 100 equal parts.” 
This contribution is made to scientists and medico-legal 
jurists throughout the whole world, to invite discussion and 190 
BLOOD AND BLOOD STAINS 
original research upon this subject, so important to the 
administration of justice in the criminal courts of all coun- 
tries where persons charged with homicide are guilty or sus- 
pected, and the evidence of blood on garments or weapons 
require the examination of the scientific medico-legal jurist. 
At the discussion of this paper before the Medico-Legal 
Society the consensus of opinion favored the following 
propositions: 
1. That there was no great difficulty in distinguishing between human 
blood and that of birds, fishes, and amphibia generally. 
2. That by careful and competent observers, with instruments of high 
power, a reliable discrimination could be made between human blood and 
the blood of mammals, when the size of the red blood corpuscles was much 
smaller than that of man, notably the ox, the horse, the goat, the sheep, the 
pig, and most mammals. 
3. That the blood of the dog, the rabbit, and the guinea pig, so nearly 
resemble human blood in the size or diameter of the red corpuscles that it 
was exceedingly difficult, if not impossible, to distinguish between them, 
and divided opinions upon this subject exists among observers, Prof. Reese, 
Formad, Reyburn, and others claiming that by the employment of high 
powers, up to 10,000 diameters, the difference in diameter becomes so great 
when thus magnified as to make it apparent in all mammals except the 
guinea pig and opossum; while Prof. Ewell and others deny that the 
results of these investigations are such as to make it certain and absolute 
when in doubtful cases, human life is at stake. 
4. All concur in the safety of the careful microscopist, who asserts pos- 
itively “ That the blood examined is consistent with human blood,” if unwil- 
ling to state positively that it is such, or who agrees with the dictum of 
Prof. Wormley in his masterly treatise that “ The microscope may enable us 
to determine with great certainty that a blood is not that of a certain animal 
and is consistent with the blood of man.” Although some might agree and 
some dissent from the same author’s assertion added to the above quotation: 
“ but in no instance does it in itself enable us to say that the blood is really 
human, or indicate from what peculiar species or animal it was derived.” 
NOTE. LEGITIMACY. 
CLARK BELL, ESQ. 
The law upon the subject of Legitimacy may be stated 
thus:— 
Legitimacy is the state of being born in wedlock—that is, 
in a lawful manner, or in accordance with law; Bouvier’s 
Law Dictionary, tit. 2, p. 67; Anderson’s Law Dictionary, 
611; Campbell’s Case, 2 Bland Ch. (Md.), 36. 
An illegitimate child is one born out of wedlock, or not 
within competent time after termination of coverture; or if 
born out of wedlock, whose parents do not afterwards inter- 
marry and the father acknowledge it, or who is born in 
wedlock where procreation by the husband is impossible : 
Smith v. Perry, 80 Ya., 563. 
By the common law the subsequent marriage of parents 
does not legitimize children born out of wedlock before mar- 
riage, but in many of the American States the subsequent 
marriage of parents works by statute the legitimacy of the 
child, notably Arkansas, Georgia, Indiana, Kentucky, Louis- 
iana, Maryland, Massachusetts, Pennsylvania, New Hamp- 
shire, Texas, and Virginia. A child born after marriage, no 
matter how soon, is born in wedlock, and presumed to be 
legitimate, and all children born in wedlock are presumed in 
law to be legitimate: Bouvier’s Institutes, 322; State v. 
Romaine, 88 Iowa, 48; Rhine v. Hoffman, 6 Jones Eq., 335; 
1 Rolle Abr., 358; 2 Bac. Abr., 84; Rex v. Reading, Lee Temp. 
Hardw., 83; King v. Luffe, 8 East., 193, Lord Ellenborough, 
Justice, sustained by authorities in many American States : 
State v. Herman, 13 Ired. (N. Car.), 502; State v. Romaine, 58 
Iowa, 46. 192 
LEGITIMACY. 
Where the mother has lived and cohabited with the father, 
and has been recognized by him as his wife and the child as 
his offspring, in the absence of any proof to the contrary, 
even though there be no evidence of a legal marriage, the 
law presumes the issue to be legitimate: Taylor on Evi- 
dence, Text-Book Series, § 649; Hargrave v. Hargrave, 2 C. 
& Kir., 701; Shotle v. Magervan, 2 Bush. (Ky.), 627. 
These presumptions may, however, be rebutted, on show- 
ing :— 
1. That the husband was impotent or incompetent, by 
Lord Ellenborougli, Justice, in King v. Luffe, 8 East., 207; 
Head v. Head, 1 Sim. & Stu., 150; Cross v. Cross, 3 Paige 
Chan. (N. Y.), 139; 23 Am. Dec., 778. 
2. Positive absence of the husband during the period in 
which the child must, in the course of nature, have been be- 
gotten, or his death, or non-access : King v. Luffe, supra ; 
it. v. Allerton, 1 Ld. Raymond, 395; Banbury Peerage, an- 
swer to 7th question, 1 Sim. & Stu., 157; State v. Britt, 78 N. 
Car., 439; Cope v. Cope, Alderson B, 1 En. & Rob., 275; 
Benny v. Philpot, 2 Myl. & K., 349; Com. v. Strieker, 1 
Browne (Pa.) Appx., 47; Wilson, v. Babb., 18 S. Car. 59; 
Hargrave v. Hargrave, 9 Beav., 255. 
By common law, if the husband was within the four seas 
at any time during the pregnancy of the wife, the presump- 
tion was conclusive that the issue was legitimate : R. v. Mur- 
ray, 1 Salk., 122; R. v. Allerton, 1 Ld. Raymond, 122. 
While the ancient policy of the English common law 
remains unchanged, the courts have in modern times taken 
evidence, which, if absolutely conclusive of non-access and 
free from all doubt, modified the old rule : Head v. Head, 1 
Sim & Stu., 160; Am. and Eng. Encyclopaedia of Law, note 
under Legitimacy, p. 225. HON. WM. P. LORD, 
Chief Justice of Oregon. CRIMINAL RESPONSIBILITY OF THE INSANE 
HOMICIDE. 
A wide divergence of opinion exists in tlie American 
States as to the legal effect of the answers of the English 
judges to the questions propounded by the House of Lords 
in the excitement growing out of the McNagliten Case in 
1843. 
1. It must be conceded that these judicial responses were 
the mere expressions of the individual opinions of the 
judges, and not decisions by a court of competent jurisdic- 
tion pronounced in a case before them ; in other words, that 
they are mere obiter dicta, and of no binding effect upon any 
court in England or elsewhere. Sir James Eitz James Ste- 
phen has well said concerning them : “ That they were mere 
answers to questions which the judges were probably under 
no obligation to answer, and to which the House of Lords 
had probably no right to require an answer, as they did not 
arise out of any matter judicially before the house: ” 
Stephen’s Hist. Crim. Law of England, vol. 2, p. 154. 
2. While these answers have been by common usage 
usually followed by the English trial judges, it is a signifi- 
cant fact that they have not received the approval of the 
High Court for Crown Cases reserved. 
3. The conviction of insane homicides in such cases as 
those of Goldstone and Cole in England, and of similar cases 
in some of the American States, when judges have followed 
the dicta of the judges, upon what has been commonly 
known as the Right and Wrong Test, has led to a strong re- 
vulsion of feeling against that doctrine, both in England and 194 
CRIMINAL RESPONSIBILITY OF THE INSANE HOMICIDE 
in the American States. The medical profession of England 
instantly protested against the answers of the English 
judges, by the resolutions adopted July 11, 1844, at the 
session of the British Association of Medical Superintendents, 
which was the year after the answers of the English judges 
were made. In some of the American States the dicta of the En- 
glish judges were followed, notably New York, Pennsylvania, 
Massachusetts, Michigan, Alabama, Ohio, and other States. 
Writers and jurists denounced the “ Right and Wrong Test’ 
on both sides the Atlantic : Brown’s Med. Juris., §§ 18 et 
seq.\ Wharton & Stille, § 59; Bishop Crim. Law, 7tli ed., §§ 
386 et seq.; Wharton’s Crim. Law, §§33 et seq.\ Ordronaux 
on Insanity, 419; Ray Med. Juris., 16-19; Bucknell & Tuke, 
p. 269; Bell, Med. Leg. Jour., vol. 2, p. 339; the same, Med. 
Leg. Jour,, vol. 7, p. 88. 
In August, 1833, an act of Parliament was passed in 
England declaring that if the homicide was insane at the 
time he committed the act a special verdict should be found 
by the jury. 
5. In the American courts the soundness of the doctrine 
of the dicta of the English judges has been severely criticised, 
and overruled, if an obiter dictum of a court can ever properly 
be regarded as overruled. The most notable case was that 
of State v. Pike, in which Chief Justice Doe, of the Supreme 
Court of New Hampshire, wrote the masterly opinion of the 
whole bench, repudiating the doctrine contained in the 
answers of the English judges : 49 N. Hamp., p. 399; 50 N. 
H., p. 369. Similar decisions followed in the Supreme 
Courts of Kentucky (Kried v. Com., 5 Bush. (Ky.), 362; 
Smith v. Com., 1 Duv. (Ky.), 224); in Virginia (Dejarnette v. 
Com., 75 Va., 576); in Mississippi (Cunningham v. State, 56 
Miss., 269); in Connecticut (State v. Johnson, 40 Conn., 136; 
Anderson v. State, 43 Conn., 514); in Iowa (State v. Mc- 
Whorter, 46 Iowa, 88; State v. Fettes, 35 Iowa, 68); in Illi- HON. REUBEN S. STRAHAN, 
Ex-Chief Justice of the Supreme Court of Oregon. CRIMINAL RESPONSIBILITY OF THE INSANE HOMICIDE. 
195 
nois (Hopp v. People, 31 111., 385); in Indiana (Bradly v. 
State, 31 Ind., 492); in Texas (Harris v. State, 18 Texas Ct. 
of App., 87); in Pennsylvania (Coyle v. Com., 100 Pa., 573); 
in Georgia (Robots v. State, 3 Ga., 310); in Massachusetts 
(Com. v. Rogers, 7 Mete., 500); in the District of Columbia, 
People v. Daly (reported in Med. Leg. Journal, vol. 7, Sept. 
No.) and more recently in the notable case of Parsons 
v. State, where Somerville, Justice, wrote the opinion of the 
bench of the Supreme Court of Alabama, a masterly and 
exhaustive treatise upon the whole subject, distinctly over- 
ruling the doctrine as answered by the English judges 
(which is, as was Chief Justice Doe in the New Hampshire 
cases, a leading case, and is reported in full in the Septem- 
ber No. of vol. 7 of Medico-Legal Journal). Mr. Justice 
Stone wrote a dissenting opinion as to certain propositions, 
but not upon the main question, and upon the “ right and 
wrong ” theory he did not dissent. 
C. The acquittal of Hadfield in England, defended by 
Erskine, was within the doctrine, as stated in State v. Pike, 
in New Hampshire, and Parsons v. State, in Alabama. 
Lord Kenyon, one of the ablest of the English judges, acted 
and decided correctly, under the law of England, when he 
stopped the case before the witnesses for the defense were 
all sworn, and directed the acquittal, as matter of law, on the 
substantial doctrine of the decision as laid down in the Ala- 
bama case. In the case of McNagliten, the eminent judge 
who tried that case, correctly applied the law of England as 
it then existed and had been administered, in directing an 
acquittal, on the assent of one of the ablest law officers of 
the crown, Sir William Follett, who admitted, upon the 
appeal of Judge Tyndale, that he must submit to a verdict 
of acquittal on the ground of the defendant’s insanity: 
(Serjeant Ballantyne, vol. 1, p. 24G.) McNagliten was de- 
fended by Mr. Cockburn, afterward the Lord Chief Justice. 196 
CRIMINAL RESPONSIBILITY OF THE INSANE HOMICIDE. 
McNagliten did not even know Sir Robert Peel, nor Mr. 
Drummond, and lie was, beyond all question, laboring under 
an insane delusion which dominated his action. His ac- 
quittal was correct under the law of England, but he would 
have been convicted under the recent dicta of English 
judges. It is doubtless true that the excitement of that era, 
which led to the extraordinary inquiry, may have largely 
influenced the English judges in framing their answers. 
7. It may be claimed that the answers of the English 
judges did not correctly state the law of England, as it had 
before that time been administered in this respect, and nota- 
bly in the case of Hadfield and McNagliten, the answers set 
up a new legal test or criterion, which upon trial has been 
found to be against the teachings of science and repugnant 
to and in conflict with the civilization of our age. 
8. The action of the English Home Secretary and the law 
officers of the crown in recent cases, indicates a great change 
in English judicial views, and the course now taken in 
England of having a full and impartial inquisition in every 
case of suspected insanity, with competent experts, conduct- 
ed by the government officials before the main trial, makes 
it extremely improbable that any insane homicide will be 
likely to be either convicted or executed in Great Britain in 
the near future. HON. ROBERT S. BEAN, 
Supreme Court of Oregon. NON COMPOS MENTIS. 
The words “non compos mentis''' have received judicial 
interpretation. The doctrine of Lord Coke, “ total depriva- 
tion of sense," is not now recognized by the courts, either in 
England or America, as correct in regard to what constitutes 
“non compos mentis Carew v. Johnston, 2 Sch. & Lef., 
280; Browning v. Beane, 2 Phil., 69; Dew v. Clark, 3 Add. 
Ecc. 79, 87; Lord Tenterden in House of Lords in Mannin 
v. Ball, Smith & Batty, 183; Buswell on Insanity, § 5, § 6; 
Commonwealth v. Schneider, 59 Pa. St., 328; Commonwealth 
v. Haskell, 2 Brews., 491; although there has been a conflict 
of American decisions, the weight of American authority 
sustains the English doctrine laid down in Mannin v. Ball, 
before cited: Hale v. Hill, 8 Conn., 39; Dennett v. Dennett, 
44 N. H., 531; Carmichael in re, 36 Ala., 514; Hovey v. 
Chase, 52 Maine, 304; Blanchard v. Nestle, 3 Denio, 47; 
Stanton v. Wetlierwax, 16 Barb. (N. Y.), 259. 
In New York, Massachusetts, and several of the American 
States, statutes have been passed defining the terms “ insane 
person,” “lunatic,” “non compos," and “insane,” so as to 
embrace all forms of insanity except “idiocy.” In many of 
the American States the statute law has made the words 
“lunatic,” “insane,” and “non compos mentis" synonymous 
and convertible terms, and provided that these embrace all 
recognized forms or phases of insanity, so that at law it may 
be said that he is “insane,” “a lunatic,” or “non compos 
mentis," whose mind is affected by general fatuity or is sub- 
ject to one or more specific delusions: Buslinell on Insan- 
ity, § 18. (Ib., p.727.) MORAL INSANITY IN THE COURTS. 
There has been a conflict of opinions and decisions of the 
courts as to moral insanity. Some confusion has arisen as 
to what constitutes and what has been recognized by the 
courts as moral insanity. Mere beliefs, opinions, or preju- 
dices, unless involving some insane delusion, do not consti- 
tute moral insanity. Opinions as to the moral quality of 
acts, unaccompanied by delusions which subvert the will and 
reason and dominate the conduct, do not constitute moral 
insanity. Moral perversity is not moral insanity. Moral 
insanity, as recognized by the courts, involves either a dis- 
order of the brain, which affects the moral faculties, or pro- 
duces an inability to discriminate between right and wrong, 
which has, as a disease of the brain, proceeded so far as to 
destroy the reasoning faculties of the mind and impair or 
destroy the volition. This has had judicial recognition in 
American courts : Com. v. Moster (Gibson, C. J.), 4 Pa. St., 
266; Forman’s Will, 54 Bar., 274; Boswell v. The State of 
Alabama, 63 Ala., 307; Wharton Horn., § 584; St. Louis Mut. 
Life Ins. Co. v. Graus, 6 Bush., 268; Anderson v. The State, 
43 Conn., 515; Buswell on Insanity, § 12; Ray’s Contribu- 
tions to Mental Pathology, 115 \per contra State v. Spencer, 
1 Zab., 196. (Ib., p.726.) INSANE DELUSIONS. 
It may be said that both the English and the American 
courts, by a long line of decisions, have established the rule 
of law to be that, the presence or absence of delusion in the 
mind of the subject was the true criterion of the presence or 
absence of insanity in any case : Dew v. Clark., 3 Add. Ecc., 
79; Wheeler v. Anderson, 3 Hagg Ecc., 574; McElroy’s Case, 
6 W. & S., 451; Am. Seaman’s Fund. Soc. v. Hopper, 33 N. 
Y., 619; Duffield v. Morris, 2 Harr., 375; Sutton v. Sadler, 5 
Harr., 459; Frere v. Peacock, 1 Rob. Ecc., 442; Stanton v. 
Wetherwax, 16 Barb., 259; Mullin v. Cottrell, 41 Miss., 291; 
Buswell on Insanity, § 14; Forman’s Will, 54 Bar., 274. 
The courts have made exceptions to this general rule, 
where “delusion” is not the criterion : 1. Insanity congeni- 
tal “ ex nativitate2. Cases where the mind has become 
enfeebled, weakened, or disorganized, due to disease, or to 
the gradual development of senile dementia. The law now 
recognizes insanity as existing in certain cases without 
delusions: Nichols v. Binns, 1 Sw. & Tr., 239; Am. Seam. 
Fund y. Hopper, 33 N. Y., 619; Regina v. Shaw, L. R. 1 C. 
C., 145; Buswell on Insanity, § 16. (Ib., p. 728.) MONOMANIA.—THE TERM SHOULD NOT BE 
EMPLOYED. 
The use of the term monomania is misleading and im- 
proper. That term among judges, lawyers, and lexicogra- 
phers has been understood to mean derangement concerning a 
single faculty of the mind, or with regard to a particular 
subject only, as defined by Webster. This has had judicial 
construction in the courts. Legally, monomania has been 
held to exist where the mind is deranged upon one subject, 
the insanity relating to one delusion, and retaining the other 
intellectual powers. It excuses only when this delusion 
leads to an insane impulse, which controls the will and judg- 
ment, obliterates the understanding of right and wrong, and 
results in the commission of an act which the accused was 
unable to resist, or to refrain from, and yielded to its dom- 
ination : Stevens v. State, 31 Ind., 485; State v. Johnson, 40 
Conn., 136; Com. v. Rogers, 47 Mass. (7 Mete.), 500; s. c. 1 
Lead. C. C., 94; Brailly y. State, 31 Ind., 492; Com. v. Has- 
kell, 2 Brewster (Pa.), 401; Com. v. Frith, 5 Clark (Pa. L. J.), 
455; Life Ins. Co. v. Teny., 21 U. S. (15 Wall.), 580; on 21 
L. Ed., 326; United States v. Hewson, 7 Bost. L. R., 361; 
Span. y. State, 47 Ga., 553; Roberts y. State, 3 Ga., 310; 
Hopps y. People, 31 Me., 385; State v. Felter, 25 Iowa, 67; 
Wesley v. State, 37 Miss., 327; Scott v. Commonwealth, 4 
Met. (Ky.), 227; and as to responsibility : Com. v. Mosier, 4 
Pa. St., 264; State v. Huling, 21 Mo., 464; Royce v. Smith, 9 
Gratt. (Va.), 704; Rex. v. Offord, 5 Carr. & P., 168; Willis y. 
People, 5 Park. Crim. R. (N. Y.), 621; Reg. v. Burton, 3 
Fost. & F., 772; Rex. v. Townley, 3 Fost. &. F., 839. MONOMANIA. 
201 
Among medical men and authors the term monomania 
means quite another thing, as was intended by Esquirol, its 
author, and so understood by all modern American, French, 
German, and Italian scientists and writers. Its use is, there- 
fore, misleading, and it is now generally abandoned by the bet- 
ter medical authorities for that reason : Vid. Article Monoma- 
nia, 2 Bell’s Medico-Legal Studies, p. 101. Maudsley, Pliny, 
Earl, and many writers and observers deny the existence of 
an insanity limited to one subject, leaving the brain normal 
and healthy on all other subjects. For these reasons the 
term monomania should not be longer employed by medico- 
legal writers or in text-books. (Ib., 729.) 
Note.—Although courts have held that insanity may exist where there is 
only one specific delusion, and the manifestations are limited to that one 
subject, with the mind clear and unimpaired on all other subjects, based 
upon the opinions of medical men and popular belief, alienists of the high- 
est attainments and largest experience deny such a condition, and they are 
undoubtedly correct. If the brain is diseased to such an extent as to pro- 
duce a state of insanity in any respect, it is difficult to conclude that the 
subject is sane in all other respects. (lb., 734.) DRUNKENNESS AS A DEFENSE. 
The law as now settled in England and the American 
States may be stated as follows: 
While drunkenness is not per se a defense upon a charge 
of crime, yet mental unsoundness, superinduced by excessive 
intoxication and continuing after it has subsided, may ex- 
cuse ; or where the mind is destroyed by a long-continued 
habit of drunkenness; or where the long-continued drunk- 
enness has caused an habitual madness, which existed when 
the offence was committed, the victim would not be respon- 
sible. For if the reason be perverted or destroyed by a 
fixed disease, although brought on by his own vices, the law 
holds him not accountable: 
Rex ®. Meakin, 7 Car. & P., 297; Reume’s Case, 1 Lewin, 76; Reniger ®. 
Fogassa, Plow., 1; 1 Russ, on Crimes (9tli ed.), 12; 1 Bishop Cr. L., (Gth 
ed.) 406; 1 Wharton Cr. L., (8th ed.), sec. 48; McDonald C. L. of Scot., 
16; 1 Hale, 4; Black. Com., 26; Beasley ®. State, 50 Ala., 149; Peo. ®. 
Odill, 1 Dak. Ter., 197; Estes ®. State, 55 Ga., 30; Baily®. State, 26 Ind., 
422; Roberts ®. People, 10 Mich., 401; s. o. 19 Mete., 402; State ®. Hund- 
ley, 46 Mo., 414; State ®. Thompson, 12 Nev., 140; Lanergan ®. People, 
50 Barb. (N. Y.), 266; Maconnehey ®. State, 5 Ohio, 77; Com. ®. Green, 1 
Ashm. (Pa.), 289; U. S. ®. Forbes, Crabbe (D. C.), 558; Stuart ®. State, 57 
Tenn, 178; Carter®. State, 12 Texas, 500; Bell’s Med. Jurisp. of Inebrie- 
ty, p. 10, and cases there cited. 
The rule of law is well settled that evidence of intoxication 
is always admissable to explain the conduct and intent of 
the accused in cases of homicide, although the rule does not 
apply in lesser crimes, where the intent is not a necessary 
element to constitute a degree or phase of the crime : 
Bell’s Med. Jur. of Inebriety, p. 10, and cases there cited. 
In cases where the law recognizes different degrees of a 
given crime, and provides that wilful and deliberate inten- Group of Ex-Chief and Associate Judges of the Supreme Court of Oregon 
EX-JUSTICE M. P. DEADY. EX-CHIEF JUSTICE P. P. PRIM. 
EX-CHIEF JUSTICE GEORGE H. WILLIAMS. 
EX-CHIEF JUSTICE A. E. WAITE. EX-CHIEF JUSTICE E. D. SHATTOCI 
EX-CHIEF JUSTICE W. W. UPTON. EX-CHIEF JUSTICE B. F. BONHAM. 
EX-CHIEF JUSTICE R. P. BOISE. JUDGE L. F. MOSHE] 
EX-CHIEF JUSTICE W. W. THAYER. 
JUDGE JOHN BURNETT. JUDGE L. L. McARTHUR. DRUNKENFESS AS A DEFENSE. 
203 
tion, malice, and premeditation must be actually proved to 
convict in the first degree, it is a proper subject of inquiry 
whether the accused was in a condition of mind to be cap- 
able of premeditation: 
Gray. J., in Hopt v. People, 104 U. S., 631; Buswell on Insanity. § 450; 
Penn v. McFall, Addison, 255; Keenan v. Commonwealth, 44 Pa., St. 55; 
Jones v. Com., 75 Pa. St., 403; State v. Johnson, 40 Conn., 136; Pirttle v. 
The State, 9-Humph., 663; Haile v. State, 11 Humphrey, 154; Smithy. 
Duval (Ky.), 224; Bosswell v. Com., 20 Gratt., 860; Willis v. Com., 32 
Gratt., 929; People v. Belencia, 21 Cal., 544; People v. King, 27 Cal., 507; 
People v. Lewis, 36 Cal., 531; People v. Williams, 43 Cal., 344; Farrell v. 
State, 43 Texas, 508; Colbath v. State, 2 Tex. App., 391; State v. White, 
14 Kan., 538; Schlacken v. State, 9 Neb., 241; 104 U. S. 
The reason of this rule of law rests upon the fact that in- 
toxication is a circumstance to be weighed in connection 
with the other circumstances surrounding the commission of 
the act in determining whether it was inspired by deliberate 
and malicious intent, and whether immediately before and 
at the time of his act the intoxication of the accused was so 
great as to render him incapable of forming a design or in- 
tent, which the jury must find from the facts in the case, 
without regard to opinions of others: 
Buswell on Insanity, § 452; Marshall’s Case, 1 Lew. Cr. Cas., 76; 
Thacher, J., in Kelly v. State, 3 S. & M. 518; Armor v. State, 63 Ala., 173; 
People v. Belencia, 21 Cal., 544. 
And because, since he who voluntarily becomes intoxi- 
cated is subject to the same rules of law as the sober man, 
it follows: that where a provocation has been received 
which, if acted upon instantly, would mitigate the offence if 
committed by a sober man, the question in the case of a 
drunkenman sometimes is, whether such provocation was in 
fact acted upon, and evidence of intoxication may be con- 
sidered in deciding that question: 
Buswell on Insanity, § 423; State v. McCants, 1 Speer, 384. 
The New York Penal Code defines precisely this question 
of responsility in that State in such cases as follows : “ § 22. 
Intoxicated persons.—No act committed by a person while 204 
DRUNKENNESS AS A DEFENSE. 
in a state of intoxication shall be deemed less criminal by 
reason of his having been in such condition. But when- 
ever the actual existence of any particular purpose, motive, 
or intent is a necessary element to constitute a particular 
species or degree of crime, the jury may take into considera- 
tion the fact that the accused was intoxicated at the time, in 
determining the purpose, motive, or intent with which he 
committed the act.” DELIRIUM TREMENS. 
The rule of law is well established, both in England and 
in the American States, that insanity produced by delirium 
tremens is a good defence to a criminal charge. Even if in- 
duced by intoxication, the victim is no more punishable for 
his acts than if the delirium had resulted from causes not 
under his control: 
Regina v. Davis., 14 Cox C. C., 563; Bell on Med. Juris, of Inebriety, 9, 
and cases there cited; J. Crisp Poole, Med. Leg. Jour., voi. 8, p. 44; U. S. 
v. McGlue, 1 Curt. 1; Wharton’s Crim. Law (8th ed.), sec. 48; People v. 
Williams, 43 Cal., 344; U. S. v. Clarke, 2 Cr. C. C., 158; Lanergan v. Peo- 
ple, 50 Barb. (N. Y.), 266; s. o. 6 Parker Cr. R, (N. Y.), 209; O’Brien v. 
People, 48 (Barb.), 274; State v. Dillahunt, 3 Harr. (Del.), 551; State v. 
McGonigal, 5 Harr. (Del.), 510; Cluck v. State, 40 Ind., 563; Bradley 
v. State, 26 Ind., 423; O’Herrin v. State, 14 Ind., 420; Dawson v. State, 16 
Ind., 428; Fisher v. State, 64 Ind., 435; Smith v. Com., 1 Duv. (Ky.), 
224; Roberts v. People, 10 Mich., 401; State v. Hundley, 46 Mo., 414; 
State v. Sewell, 3 Jones (N. C.) L., 245; Cornwell v. State, Mart & Y. 
(Tenn.), 147; Carter v. State, 12 Tex., 500; Boswell v. Com., 30 Gratt. 
(Va.), 860; U. S. v. Drew, 5 Mason C. C., 283. MEMORANDUM. 
The rule of law govering memorandum may be stated as 
follows: 
A memorandum is admitted in evidence only for the pur- 
pose of showing the existence of such facts or circumstances 
which it contains, and for no other purpose. And it is open 
to explanation to the same extent that it would be if the 
words had been spoken instead of being written. 
A memorandum thus made in the usual course of business 
may be received in evidence, even though the witness is 
unable after its examination to state the particulars from 
recollection : Russell v. Hudson River R. R. Co., 17 N. Y., 
134; Halsey v. Lursebaugh, 15 N. Y., 485; Guy v. Mead, 22 
N. Y., 462; Howard v. McDonough, 77 N. Y., 592; Mayor of 
N. Y. v. 2d Av. R. R., 102 N. Y., 572. 
But the witness must be able to state that he once knew 
the facts contained in the memorandum to be true; that he 
made it at or shortly after the time they transpired, which 
he then intended to make correctly and that he believes it 
to be correct, and he must also be able to verify the hand- 
writing as his own, and the facts stated must be facts of his 
own knowledge and not on information derived from others : 
Haven v. Wendell, 11 N. H., 112; Slierr v. Wiley, 18 Pick., 
558; Trinth v. Johns, 3 Gray (Mass.), 517; Crillueten v. 
Rogers, 8 Gray, 452; Sticlmey v. Bronson, 5 Minn., 215; 
Marely v. Schultz, 29 N. Y., 346; Nicoll v. Webb, 8 
Wheaton (U. S.), 326; Ocean Nat. Bk. v. Caryle, 9 Hun 
(N. Y.), 239. TENANCY BY THE CURTESY. 
Tenancy by the curtesy, legally defined, is an estate for 
life created by the act of the law. When a man marries a 
women seized at any time during the coverture of an estate 
of inheritance in severalty, in coparcenary, or in common, 
and hath issue by her born alive, and which might by possi- 
bility inherit the same estate as heir to the wife, and the wife 
dies in the life-time of the husband, he holds the land during 
his life by curtesy : 4 Kent’s Com., 13th ed., 25; Litt., § 35; 
2 Blackstone, 126; 1 Bishop, M. & W., § 473; Heath v. 
White, 5 Com., 228; Rawlins v. Adams, 7 Md., 26; Carring- 
ton v. Richardson, 79 Ala., 101, et seq. 
The law imposes four requisites before the husband can 
take by the curtesy, viz.: 1, there must be a legal marriage ; 
2, there must be seizin by the wife during coverture; 3, there 
must be issue capable of inheriting the estate; 4, the wife 
must be dead : Jackson v. Johnson, 5 Cowen (N. Y.), 74, 
95, 102; s. c. 15 Am. Dec., 433; Hunter v. Whitworth, 9 Ala., 
967; Furguson v. Tweedy, 43 N. Y., 543; Stewart v. Rees, 50 
Miss., 776; Monroe v. Van Meter, 100 111., 347; Wheeler v. 
Hotchkiss, 10 Conn., 225; Withers v. Jenkins, 14 S. Car., 
597; McDaniel v. Grace, 15 Ark., 465; Carpenter v. Garrett, 
75 Va., 129-133; Winkler v. Winkler, 18 W. Ya., 455. 
The marriage must be a lawful one. If it be declared void 
during the wife’s life the tenancy fails. If valid at the death 
of the wife the husband takes by the curtesy. It could not 
be declared void after her death to affect his right: Wash- 
burn on Real Prop., 5tli ed., 172; Stewart on Husband and 
Wife, § 153; Wheeler v. Hotchkiss, 10 Conn., 225; Mattocks 208 
TENANCY BY THE CURTESY. 
v. Stearns, 9 Vt., 326; vid. also Smoot v. Leggate, 1 Stew. 
(Ala.), 590. 
The wife must have been seized of the estate some time 
during coverture; it need not be at the time of her death or 
at the time of the birth of the child : Mercer v. Sheldon, 1 
How. (U. S.), 37; McDaniel v. Grace, 15 Ark., 4G5; Withers 
v. Jenkins, 14 S. Car., 597; Upchurch v. Anderson, 59 Tenn., 
410; Haynes v. Baum, 42 Vt., 686; Jackson v. Johnson, 5 
Cow. (N. Y.), 74; Comer v. Chamberlain, 6 Allen (Mass.), 
1G6. 
Before the death of the wife, after marriage, birth of issue 
and seizin, the right of the estate by the curtesy is called 
“initiate,” and it is contingent then on the death of the wife? 
and is then assignable : Rice v. Hoffman, 35 Md., 344; Fos- 
ter v. Marshall, 22 N. H., 401; Winne v. Winne, 2 Laws (N. 
Y.), 439; Briggs v. Titus, 13 R. I., 136; Gardner v. Hooper, 
3 Gray (Mass.), 438; Mechanics’ Bk. v. Williams, 17 Pick. 
(Mass.), 438; VTicks v. Clarke, 8 Paige (N. Y.), 161; Van- 
Duger v. VanDuger, 6 Paige (N. Y.), 366. 
After the death of the wife curtesy “initiate” becomes 
curtesy “ consummate.” The estate is then vested. It vests 
by operation of law and without assignment: Wheeler v. 
Hotchkiss, 10 Conn., 225; Watson v. Watson, 13 Conn., 83; 
Oldham v. Henderson, 5 Dana (Ky.), 254; Rice v. Hoffman, 
15 Md., 344; Williams v. Perkins, 2 Me., 400. 
In the American States this estate is greatly modified by 
State statutes. In some States it is abolished. In some, 
where the statutes are silent, the common law rule prevails, 
and in some States the common law rule is modified by 
st atute. Vid. Stimson on Am. Stat. Law, § 3,300, et seq. 
also Stewart on Husband and Wife, § 160.