often leave the impression that they have been unjustly, if not cruelly, dealt with.1 § 399. It has been already remarked that in most instances recovery takes place gradually, and is completed only after a period, more or less long, of convalescence Nothing, therefore, can be more chimerical than the idea of fixing on any precise moment when all disease has departed and perfect health is established; and yet this is what we are called upon to do when required to determine, as we sometimes are in criminal cases, at what time the accused began to be responsible. To contend that a convalescent maniac may be irresponsible one day and responsible the next, would be no less absurd than to say to one recovering from inflammation of the lungs, that as he valued his life he must not leave his room to-day, though to-morrow he might safely expose himself to the severest inclemency of the weather; and to believe that the former is perfectly sound, because laboring under no' hallucination and attacked by no fits of fury, would be as erroneous, as to consider the respiratory functions of the latter sound and vigorous, because we hear no cough and see no difficulty of breathing. The time that has elapsed since the unequivocal insanity of the accused is therefore an important element in the determination of his mental soundness. Just as exposure to bad weather, a week after an attack of inflammation of lungs had begun to subside, would be more likely to reproduce the disease than it would a month afterwards; so the longer the time since an attack of insanity has been apparently cured, the less likely is the cerebral irritation to be renewed by sudden provocations or other causes that tend to produce it. Ample time must be allowed to cover the period of convalescence, and if it be difficult to fix upon the exact duration of this state, so much greater the necessity of caution in determining the responsibility of the accused. Here it is often a merit to doubt, and justice requires that the accused should have the benefit of our doubts. 1 A memorable case of this description —memorable for the success which followed the representations of the patient, and the utter groundlessness of tin- charges which he brought — occurred in Philadelphia, in 1849. A man named Hinchman, who was placed in the Friends' Asylum for the insane in Frankford, because, as the evidence showed beyond a doubt, be was violently and dangerously insane, brought an action of conspiracy against every individual the least concerned in the measure, — his mother, sister, cousins, the sheriff", a passing traveller, the physicians of the asylum, and the physician who signed the certificate, and others, — and he succeeded in obtaining heavy damages. CHAPTER XV. LUCID INTERVALS. § 400. It is well known that many diseases — especially of the class called nervous — observe a law of periodicity which is not uncommon in the actions of the animal economy. One effect of this curious law consists in an intermission of the outward manifestations of the disease, so complete as to bear the appearance of a perfect cure, and this, in the present state of our knowledge, is all that we can, with certainty, say of it. As to the change that takes place in the organic condition of the part affected, during the intermission, we can at best hazard nothing more than a rude conjecture. We have no warrant for believing that the pathological affection itself entirely disappears with the symptoms that arise from it, and perhaps never shall have, until we are able to explain why, after such disappearance, the tendency of the disease to return at certain intervals should still remain; or, in other words, wherein the final, perfect cure differs from the temporary intermission. But in view of the established fact that organic disease often exists without producing its ordinary symptoms, or revealing itself by any appreciable sigifs, it seems the more probable supposition, that the pathological condition of the affected organs does not disappear entirely during the intermission, but continues with, perhaps, a modified intensity. § 401. The slightest examination will convince us that, in the most complete intermission of any disease that affects the whole system to some extent, the patient is far from enjoying sound health, or free from every indication of morbid action. A greater contrast in the matter of health can scarcely be presented in the same individual, than that between the paroxysm and the intermission of a quotidian fever; yet none will say, after the former has passed off, and the patient, no longer shaking with cold nor parched with heat, is able to arise and give some attention to his duties, that he is entirely well. Better, no doubt, he is; but his mind is weak, his stomach declines its once favorite food, a little exertion overcomes him, a certain malaise not easily described pervades his whole system, and which, though not excessively painful, is something very different from the buoyant sensation of health. We are therefore bound to believe that the disease still exists, though its external aspect has changed. And here it may be as well to remark, that we must not be led by an abuse of language to attribute that to the disease — to the pathological condition — which belongs only to one of its symptoms. When the epileptic, a few days after one of his frightful convulsions, appears to have regained his customary health, no intelligent physician imagines that the proximate cause of this disturbance has vanished with the fit, leaving tbe organ it affected as sound as ever. The fit itself, which is a mere symptom, is indeed of periodical occurrence, but the pathological condition on which it depends, continues, slowly and surely, though imperceptibly, to undermine the powers of the constitution. The general expression of all our knowledge on the subject of the intermission of diseases is, then, that certain pathological conditions give rise, among other phenomena, to some that disappear for a time, only to recur after an interval of more or less duration. § 402. That insanity, or rather mania, is one of the diseases that are subject in some respects to this law of periodicity, is universally admitted; but to what extent the law operates, is a point on which there is much diversity of opinion. There are few cases in which wo may not observe various periods in their course, when the severity of the symptoms is greatly alleviated; when calmness takes the place of fury, and a quiet and sober demeanor succeeds to noisy and restless agitation; when reason, driven from her throne, seems to be retracing her steps and struggling for her lost dominion. In all this, however, there is nothing different from what occurs in many, if not the greater proportion, of chronic diseases. In mania but in no other form of insanity, this abatement of the severity of the symptoms may amount to a complete intermission, when the patient is conscious of his true condition, converses rationally, and admits his having been insane. But, that the intermissions of mania are ever so complete that the mind is restored to its original integrity, or so sudden as to justify the statement of Baron Rolfe, that " such is the nature of the mind that it might be one minute sane, and another minute insane,"l would seem scarcely probable, from the fact, that the very seat of the pathological changes is the material organ on which the manifestations of the mental phenomena depend. For if the mind be rendered as sound as before the attack, it necessarily follows that the brain is equally restored, since in point of health they stand to each other in the relation of cause and effect. But as there is no proof that such is the case, and as the supposition is not supported by what we know of pathological actions, we have no right, at present, to conclude that the physical condition on which mania depends is entirely removed during the intermission. We are thus led to scrutinize a little more closely these periodical restorations .of the insane mind, or lucid intervals, as they are called, in order to ascertain if possible what is the actual state of the mind at these times. But before doing this, it will be proper to show what is understood in law by lucid intervals, as explained by eminent legal authorities. |