commends itself to medical men was never more clearly and succinctly expressed than by Lord Bramwell when in the Dove case he asked, "Could he help it?" Could he or she help it? That is the real practical question at issue in every case in which the defense of insanity is set up. Was the lunatic free to choose, or under the duress of disease? Was his will incapable or inept? But Lord Bramwell and those who think with him argue that it is sufficiently proved that the lunatic could help it if he knew the nature of his act—viz., that it was killing; the quality of his act—viz., that it was a crime; and also that it was wrong in the sense of being forbidden by law. Whereas medical men, almost without exception, maintain that a lunatic may be able to know and express the nature and quality of an act and its wrongness, and yet be as unable to resist doing it as he is to abstain from jumping under a smart electric shock; and that knowledge of the nature and quality of an act and its wrongness is not in the regions of pathology any measure of will-power. And not only medical men, but judges, have perceived this. The late Lord Chief-Justice Cockburn said, "The power of self-control, when destroyed or suspended by mental disease, becomes, I think, an essential element in the question of responsibility." And Mr. Justice Stephen has said, "It ought to be the law of England that no act is a crime if the person who does it is at the time when it is done prevented by defective mental power, or by any disease affecting his mind, from controlling his own conduct, unless the absence of the power of self-control has been produced by his own default." This statement of the law, which has been verbally amended by Dr. Bucknill, really covers all that medical men have ever contended for, and, having received it from so high an authority, it is their duty to do their best to secure its acceptance, and provide trustworthy tests of loss of self-control.
Now, impairment of will, or loss of self-control, more or less pronounced, is, according to medical men, the first, last, and universal element in insanity, and ranges from a trifling reduction in the check-action which we exercise on the ordinary currents of thought and feeling down to paralysis of the sphincters. Dissolution—and insanity is dissolution—implies a reversal of evolution, and in insanity we have, as Dr. Hnghlings Jackson has taught us, a process of undevelopment, or taking to pieces, in the highest centers, which are the crown or climax of nervous evolution. In it we have "a descent from the least organized, most complex, and most voluntary, toward the most organized, most simple, and least voluntary." There is in every case of insanity impairment of voluntary control, and as a consequence of this there is more or less license given to those lower mental functions which are during sanity under voluntary control, and which become then overactive,