The Canadian

Journal of Medicine and Surgery

A JOURNAL PUBLISHED MONTHLY IN THE INTEREST OF
MEDICINE AND SURGERY

VOL. XV.

TORONTO, JANUARY, 1904.

NO. I.

Original Contributions.

THE CARE AND TREATMENT OF THE CRIMINAL.*

BY C. K. CLARKE, M.D.,

Medical Superintendent, Rockwood Hospital, Kingston.

THE criminal has always been the most attractive person in the community, if we regard him from the standpoint of popular interest, and that this fact is generally recognized may easily be verified by a brief study of the daily newspapers. In a crude way we admit that, on "general principles," it is in the interests of the state that the criminal should be locked up, and the average man is not slow to say that punishment is meted out as a deterrent to the offender, and a warning to others who might be tempted to commit crime.

To-day the criminal is being studied and classified in a way that will result in his being cared for and treated in a more satisfactory manner than is at present the case, and with much better protection of the rights of the state. In taking up the question of the treatment of the criminal the first error to be avoided is that of confounding defect with disease, because without this distinction the whole question becomes muddled. Even Bosanquet does not seem to have fully grasped the difference, and in his work on the "Philosophical Theory of the State" writes about the "cure of the offender by medical treatment," as if there was always some disease to cure; and when he comes to write of the reformatory theory it is more patent still that he is not fully in touch with the facts now fully accepted by physicians, who have arrived at conclusions by practical methods. In dealing with the

*Read at meeting of Executive Officers of Provincial Boards of Health, held in Peterboro', September 10th, 1903.

question, I cannot lay claim to any great originality, and the views presented are those shared by physicians who have made a practical study of the criminal, and who hope that the day of radical reform in penology is not far distant.

The subject is, of course, an immense one, and there will not. be time to take up the social and economic factors at work in the production of certain groups of criminals, and incidentally certain kinds of crime, but for fear that all present may not have a clear conception of the different classes of criminal ordinarily met with, I shall briefly refer to a simple classification: (1) The criminal insane; (2) Moral imbeciles; (3) Instinctive criminals; (4) Occasional criminals; (5) Habitual and professional criminals; (6) Accidental criminals.

The insane criminal, or properly speaking, the criminally insane man, that is, the criminal who commits a crime as the direct result of mental alienation, is not recognized by law, as a general rule, and his abnormal condition of mind must be very apparent, before either judge or jury can be brought to believe in the necessity of saving the prisoner from the rigors of the law. The result is that the death penalty is frequently imposed, even in cases where brain disease is clearly marked, simply because the unfortunate sufferer from the disease is supposed to know the difference between right and wrong in the abstract, a difference that nearly every patient in a hospital for the insane can give with satisfactory glibness. However, my views on this subject have been expressed so frequently, both publicly and privately, that I shall not weary you with them. To show, however, that the foregoing statements are not beyond the mark, it is morally certain that several insane murderers were hanged in Canada during the last few years, one of whom was actually arrested in the wards of an asylum for the insane, and tried without the slightest reference to his mental condition. In Germany, of 144 persons who were tried and eventually found insane, only 38 were recognized. as insane before the judge, a condition of affairs rather startling in a country noted for the thoroughness of its methods. To those of us familiar with the everyday experiences in a hospital for the insane, perhaps the figures are not so surprising as they might appear to others not conversant with the popular idea of insanity, an idea not so far removed from the conception that insanity is in itself a species of crime; certainly something to be ashamed of. The present methods of attempting to detect the insanity of a criminal are inadequate and crude, especially when the mental condition of a prisoner is supposed to be established by a battle royal between rival lawyers and so-called experts in open court. Frequently those asked for opinions are refused permission to examine the prisoner, and the evidence becomes an attempt to

solve a problem more intricate than that of squaring the circle. It is wonderful though how often even physicians are anxious to square this circle; and the anxiety is generally in inverse ratio to the experience they have had. Of course common sense dictates that the proper time to examine the supposedly insane criminal is before trial, and it is probable that dignified and competent men, familiar with the aspects and manifestations of brain disease, can be found to give judicial opinions of even greater value than those of twelve jurymen, who, in all probability, never saw a case of insanity for more than five minutes in their lives.

A short visit to a penitentiary will soon convince the interested observer that justice has not always been done, and when I look over the endless list of insane persons sent from the penitentiary to Rockwood, suffering from chronic mental maladies, developed long prior to their incarceration in the prison, it is more than evident that man's inhumanity to man can be studied with painful reality at our own doors. Even the victims of gross brain disease are not exempt, and general paresis has time and again been seen among the convicts.

Moral Imbeciles.-The typical moral imbecile is one who is devoid, or nearly devoid, of moral qualities, just as we find some children deficient in intellectual qualities; such children are absolutely incapable of understanding the ordinary social, religious, and educational influences, and are almost invariably deficient in intellect as well as morality. Many, I might say most of them, are amiable, but drop into criminal acts without the slightest exhibition of what we call viciousness; indeed, the typical imbecile is rarely vicious in the true sense, he commits his crimes in the most innocent manner possible, and never realizes a sense of responsibility, simply because such feeling is an impossibility. Such cases reach me quite commonly, and some of the crimes committed by them are most astounding. All or nearly all, are easily managed when under proper care.

The Instinctive Criminal.—Some writers are inclined to place the moral imbecile and the instinctive criminal together, but I think a marked difference exists, for, while the moral imbecile is not usually vicious nor necessarily criminal, instinctive criminals are vicious from the outset. They reveal criminality in its most marked state, and while they form only a comparatively small proportion of the population of a prison, it is the element to be considered most seriously in the discussion of the care and treatment of the criminal. These people are not only mentally, but also physically abnormal.

In childhood they may be precocious, vicious, with sexual perversions of the most remarkable character, when at complete development they are moral monsters full of sensuality and self

seeking impulses. Their depravity is absolutely beyond reach, their claims to mix with society untenable, and their degeneracy a menace to others not quite so low in the social scale.

Occasional Criminals.-The occasional criminal, who is not so far removed from the normal, as the members of the previous class, is one in whom weakness is the chief characteristic. Under ordinary circumstances he gets along fairly well, but if environment and circumstances are favorable to his fall he cannot resist temptation. If properly guided and cared for, he may be a useful citizen; if admitted to our so-called reformatories, ninetynine times out of a hundred he will become that scourge of society known as the habitual criminal. As Ellis has so well said, "The steps by which the occasional criminal, aided on the one hand by neglect, on the other by the hot-bed of the prison, develops into the habitual criminal, are slow and subtle that is one of the tragedies of life."

The Accidental Criminal.-The accidental criminal, or, as he is sometimes called, the criminal by passion, must also be referred to, although I confess when it comes to suggesting what should be done with him, I shall feel that it would have been much simpler to have left him out of the classification. The criminal by passion is, in the majority of instances, a normally constituted person, who, stung by some great injustice or wrong, takes the law into his own hands, and in a moment of passion commits a crime.

Now, having admitted that criminals are to be classified under some such headings as those suggested, what are we to think of our system of prisons and so-called reformatories. These are built to accommodate so many criminals who are presumably all of the same class, and who are from the very first herded together with as much regard to classification, as if they were so many sheep.

The one idea present is apparently that of punishment, an idea that is not tenable for one instant for the classes that are admittedly abnormal. That this is the assumption is easily demonstrated, if we recollect that the law is quite able to apportion the length of time it is necessary to deprive a man of his liberty, for committing crime. One magistrate will give a thief two years for stealing a loaf of bread, while the society thief may receive six months for the misappropriation of $10,000. Another magistrate adopts a different rule, and still has the law for his guide-in other words, to quote from Gilbert's "Mikado," "they make the punishment fit the crime," theoretically, at least. As Professor Ferri remarks, "Up to recent times the criminal has been regarded as a kind of algebraic formula, the punishment has been proportioned not to the criminal, but the crime. What should be done is to attain scientific justice by ascertaining the reasonable treatment of abnormal members of society, not only