Popular Science Monthly/Volume 46/December 1894/Responsibility in Crime from the Medical Standpoint
| RESPONSIBILITY IN CRIME FROM THE MEDICAL STANDPOINT. |
By SANGER BROWN, M. D.,
PROFESSOR OF MEDICAL JURISPRUDENCE, RUSH MEDICAL COLLEGE, CHICAGO.
THE reason why a physician should be called upon to discuss such a subject as responsibility in crime must be because some organ or organs of the body are concerned, and he ought to know more about the structure and function of the bodily organs than other people. I believe medicine must furnish all the essential fundamental facts in the study of this subject.
According to the medical view of responsibility in crime, the mental status of the individual has to be investigated. In times past, a wide diversity of views has obtained regarding mind. Popularly expressed, some of the salient features of the view which has obtained for several centuries past have been that mind was a special endowment, bestowed by the Creator upon man, and upon no other animal. In some way not quite clearly understood, a will was also given to man, by which he was allowed a sort of freedom to choose as to whether he should allow the Creator to control his mind, or whether he should yield the management of it to an opposing power or Satan. Various manifestations on the part of the individual were regarded from time to time as evidence that either one power or the other had control, according as his conduct corresponded or not with what was commonly regarded as the best interests of the society in which he lived. The ordinary symptoms of acute mania were regarded as positive evidence that the evil one had possession, and the treatment consisted in placing upon the afflicted person charms, amulets, etc., which were regarded as obnoxious to the evil power, with the hope of making his tenancy uncomfortable, and thus inducing him to withdraw.
This view is the last survivor of those once so prevalent, which sought to explain everything of a mysterious nature by hypothecating an omnipotent personality presiding over it, and it prevailed exclusively during the early growth and development of our present criminal law.
Now, it is the proper province of modern medicine to study the construction and function of all the bodily organs, but for various reasons the brain has been the last of the larger and more important organs to be carefully studied; within the last decade, however, it has been very thoroughly investigated.
The result of that study tends to show—indeed, has demonstrated—that the functional product of the brain is mind, in precisely the same sense that bile is the functional product of the liver; that one process illustrates just as forcibly the influence of a mysterious force or power as the other.
The product of the liver, the bile, will vary according to the size, quality, and condition of the organ and the forces acting upon it; and the same is true regarding the functional product of the brain, the mind. Without liver there is no bile, and without brain there is no mind. At least the physician only investigates mind, which is a functional product of brain. The analogy, however, between brain and liver does not hold throughout, because after birth, and from that period to maturity, and indeed while
Fig. 1.
life lasts, the brain is ordinarily exposed to impressions made by an ever-changing environment, while the environment of the liver remains practically uniform.
It may be conducive to a clear understanding of the medical view of mind, and therefore of responsibility, to examine objectively the organ itself, and briefly the manner in which its functions are studied by the physician. I need hardly remind you that the brain is a double organ, and therefore only one half of it need be shown.
Figs. 1 and 2 are exact representations of the outer and mesial surfaces of the human brain. Like many other organs of the body, its functional activity depends upon the presence of cells, the bodies of which are exclusively found upon its surface, extending to a depth varying from one eighth to one fourth of an inch, and constituting the so-called
Fig. 2.
gray matter of the brain. The convoluted arrangement of the surface, as can readily be understood, more than doubles its area. Beneath the gray matter, or cortex, is found the white matter, which consists of fine fibrous processes extending from the bodies of the cells in the gray matter, and connecting those in one part of the cortex with those in another part.
Fig. 3 shows the course of the fibrous processes of the cells of the cortex of the brain as they pass from one convolution to another, connecting together the various cell bodies.
Fig. 4 shows a cell and its processes which properly constitute the essential anatomical and physiological unit of the brain, and indeed, speaking more generally, any nervous system.
Fig. 5 shows how these cells in the cortex, or gray matter of the brain, besides sending out processes as already described, also send processes to cells distributed the whole length of the spinal cord. These cells in the spinal cord in their turn send similar processes out along the nerves, to terminate in the skin, muscles. the eye, the ear, etc., all of which in neurology are called end organs; and thus a passage is afforded for impressions made upon these end organs by the environment to reach the cells in the cortex, and for impulses to return from the cells in the cortex to the end organs, perhaps producing, restraining, or regulating movements in them.
Now a few words as to methods of investigation. Figs. 6 and 7 are charts showing the areas in the brain presiding over certain functions as thereon indicated. Take, for instance, the leg center. A case is found with sudden, complete, and permanent paralysis of the leg; after a few months the person dies, and upon examination of the brain and spinal cord it is observed that a hæmorrhage has destroyed the cells in the part of the brain here indicated. Now, as might be expected when the body of a cell is destroyed, its processes perish; hence, when consecutive sections are made across a strand composed of these cell processes, the bodies of which have been destroyed, and the sections are placed in a solution of coloring matter, it is found that the fibers which have perished take a different color from those which have not, and thus their position may be determined. In this case, by this method, a large strand of fibers which have perished may be
Fig. 3.
traced from the brain downward very near to the lower extremity of the spinal cord. This is known as the clinical method of study. These centers have also been removed in the course of surgical procedures, with the invariable result of producing a corresponding paralysis; and similarly they have been stimulated by electrical currents directly applied to them, and movements produced in the corresponding parts. This latter method is known as the excitation method; to this, as practiced upon the brains of monkeys some thirty years ago, we are indebted for the commencement of the study of cortical localization, and indeed for the removal of psychology from the realm of speculation to that of scientific demonstration.
The method of removing certain cortical areas of the brain and then noting the effect is termed the extirpation method; it 
Fig. 4. was by this method, practiced upon monkeys, that Prof. Schäfer, of London, and myself established the position of the center for vision in that animal. The monkey's brain is so similar to the human brain that with some modification results may be transferred from one to the other.
Fig. 8 shows the part of the monkey's brain which, when removed, produces blindness in the corresponding half of each eye, and Fig. 9 shows the parts which, when removed, produce complete and permanent blindness in both eyes. Now, while the positions of the areas for the other special senses have not been so satisfactorily demonstrated, the existence of such centers can not be doubted.
With these data, and the aid of Fig. 10, a fundamental step in the process of mental development may be investigated.
By way of the route as indicated in the figure, an impression made upon a specially constructed end organ, the eye, is transmitted along the cell process constituting the optic nerve, and so onward till it reaches a cell, or probably cells, in the occipital lobe; thence by means of the communicating fibers constituting the white matter, and previously described, the arm center is excited and a motor impulse passes out to the muscles moving the arm, and the hand is put into the flame; immediately a second impression is conveyed inward to the pain center and thence to the arm center, from which a second impulse emanates, resulting in a withdrawal of the hand. Finally, after one or more experiences of this kind, the impression produced by the pain being so much stronger than that produced by seeing the candle flame, the attempt to seize it is inhibited, and it finally comes about by means of these association fibers that the sight of flame immediately excites this inhibitory center. The cells and processes concerned transmit the impressions more readily by each repetition until the result becomes uniform; the child has learned something, and finally the desire diminishes. By the process of induction
Fig. 5.—a, skin on the surface of the body; 17, a sensory cell in the medulla oblongata; b, sensory cell in the cortex of the brain; c, motor cell in the cortex of the brain; D, cell in the cerebellum where muscular movements are coordinated; 3, motor cell in the spinal cord; m, muscle. The course of a stimulus at "a" can readily be followed to the cortex of the brain and back again to the muscle, resulting in a muscular movement.
from simple examples like this, those which are more complex may be explained. Here Nature inflicted the penalty in the form of bodily pain, which resulted in the establishment of a permanent inhibitory center. In a similar way society attempts, by the various influences and modes of training to which it subjects children, to establish in them permanent and sufficient inhibitory centers which shall enable them to conform to the various artificial restraints imposed by an advanced civilization. And in the latter, as in the former case, when the inhibitory impression has 
Fig. 6. become well established the desire diminishes. Each successful resistance of temptation renders resistance more easy and certain.
In the former as well as in the latter case the readiness with which these inhibitory impressions are received and retained depends upon the quality of the cerebral tissues, the cells.
In the lower forms of idiocy, individuals are often seen who never can be taught to refrain from putting their hands into a candle flame, and the well-recognized criminal class is largely composed of individuals whose cerebral tissues are of so inferior an order that permanent and sufficient inhibitory centers can not under any circumstances be so established as to enable them by themselves to conform to the restraints which civilization imposes. Sound and successful training attempts to establish these centers of inhibition, and not to prevent their formation by keeping 
Fig. 7. the individual in ignorance of the conditions which demand their exercise. When young people with this false training are thrown upon their own resources, great suffering is almost sure to follow.
While doubtless in this country a large proportion of the individuals composing the criminal class are such by reason of defective brain tissues, it is wellnigh certain that a considerable number might never have entered it if from the start they could have had proper training.
A thorough musician may get better music from a defective instrument, with whose defects he is familiar, than a poor musician can get out of a perfect instrument.
Considered from a medical standpoint, habit may be regarded as a tendency which certain correlated brain cells have to act together from frequent repetition having rendered it easy for an impulse to pass from one to the other, with the production of a more or less uniform result. Thus we are indeed literally creatures of habit.
By the time an individual has reached maturity it is observed that he responds to the influences of his environment with more or less uniformity, and in a way peculiar to himself. The nature of this response constitutes his character. If he has strong impulses, which he uniformly inhibits in a manner favorable to the best interests of the society in which he lives, he becomes known as a man of strong character, and finally of established character, and is trusted accordingly. On the other hand, there are individuals
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| Fig. 8. | Fig. 9. | |
in whom the response to their environment is so variable that they never succeed in establishing a character, and are never trusted.
At one extreme are found individuals with cerebral tissues of so high a quality that they would establish a high character under the most unfavorable circumstances; and at the other extreme, individuals who would never establish a character under the most favorable conditions; but the great mass of individuals lies between these extremes, and with them the influences of the environment determine their status.
The social and legal penalties visited upon transgressors undoubtedly form a strong and constant stimulus to the inhibitory centers, and the more so in proportion as the individual feels sure that he can not escape from them. A strict and speedy administration of the penal laws should go hand in hand with an intelligent system of training.
It will readily be conceded that no two individuals have exactly the same degree of responsibility, but all must be held to equal responsibility under the law, until it shall be demonstrated in certain cases that a given person is by reason of defective cerebral tissues unable to support the social relation, in which case society should permanently restrain him. This decision should be reached by experts, who would carefully compare the environment to which the individual had been exposed with his mental state, or the functional product of his brain. This, I believe, has actually been done in some States by the enactment of the habitual criminal law, which provides for the perpetual restraint of these cases, without regard to the nature of the last offense.
Without at all suspecting the anatomical and physiological conditions upon which it depends, many intelligent observers, who have been intimately associated with the criminal classes in prisons, reformatories, etc., agree as to the fact that a large proportion are unable to resist the commission of crime, even under the most favorable circumstances, and a still larger proportion under the unfavorable circumstances in which their defective organization tends to force them.
A commission of experts appointed by the State to thoroughly examine the inmates of prisons, to determine their mental status, might do much, by effecting the permanent restraint of certain cases, to diminish crime and the cost and suffering it entails, with a fuller measure of justice toward all parties concerned.
A few words in regard to heredity, by way of digression. It is not disputed that the form which the aggregation of cells takes entering into the structure of a man's nose may be distinctly hereditary, and it is no less reasonable to suppose that variations in the convolutions of the brain are equally hereditary; and that, influenced by the same or a similar environment, the functional product observed in the child will be similar to what obtained in the parent that is, practically, crime is often hereditary, and to the same extent so may be any other mental tendency.
Finally, a few words in reference to insanity and criminal responsibility. Practically the best definition of insanity is that of Dr. Maudsley, which is substantially this: Insanity is a disease of the brain, producing such a change in the mode of feeling, thinking, and acting as to render the individual unable to support the ordinary relations of life. The question of responsibility is rarely raised in well-developed cases, where the disease of the brain renders the centers inactive and the person sits and mopes in silent misery, or in the cases where the disease of the cerebral structures is so severe as to constantly stir them to irregular and unwonted activity, prompting the individual to laugh, weep, sing. shout, fight, and pray, perhaps all at the same time as nearly as possible, quite independent of the environment.
The cases of insanity in reference to which the question of responsibility arises are those whose cerebral substance is only mildly affected by disease, so that in many ways the individual still reacts
Fig. 10.—The course of the several impulses is indicated by the arrows. An explanation of the figure is facilitated by reference to Fig. 5.
to his environment as formerly, especially in so far as his routine duties are concerned; but in other things, where the cells concerned have been less strongly, steadily, and permanently impressed, the disease of the cerebral tissue is sufficient to effect some degree of change in the nature of his response to his environment from what had been usual to him, and it is by studying the quantity and quality of this change that the alienist determines the existence of insanity. Any specific act by itself does not necessarily afford evidence of insanity, for there is nothing an insane person can do that a sane person may not do.
The experienced alienist by thorough investigation determines as far as possible what has been the previous environment of a person alleged to be insane, and how he habitually reacted to it, and then makes a comparison between that and the manifestations which have been regarded as constituting evidence of insanity. When it is proved to the satisfaction of society that a given act was clearly the result of disease of the brain producing insanity, the individual is usually excused; but until the public becomes more generally informed regarding the bodily basis of mental manifestation, and comes to understand more clearly how and where to look for evidence of insanity, many will be held to be responsible who, according to the intention of the criminal laws, are not so; and some will be excused who are fairly responsible.
It is for physicians to determine the part played by bodily defect or disease in the commission of crime. Society in general must, with this information, determine the degree of responsibility and decide upon the punishment.
