These conditions were much improved by the action of the Sixty-fourth Congress in 1917. This definitely excluded "all idiots, imbeciles, feebleminded persons, epileptics, insane persons; persons who have had one or more attacks of insanity at any time previously; persons of constitutional psychopathic inferiority," etc., or "persons not comprehended within any of the foregoing excluded classes who are found to be and are certified by the examining surgeons as being mentally or physically defective" or persons likely to become a public charge. Section 9 provided that it shall be unlawful for any person, "including any transportation company," to bring either from a foreign country or any insular possession of the United States any alien afflicted with idiocy, insanity, imbecility, feeblemindedness, epilepsy, constitutional psychopathic inferiority, etc., and subjected to a fine any person or persons so doing. The Secretary of Labor was also authorized to detail inspectors and matrons to duty on vessels carrying immigrants, who shall "report to the immigration authorities in charge at the port of landing any information of value in determining the admissibility of such passengers that may have become known to them during the voyage." It also provided that a mental examination of all arriving aliens should be made by medical officers of the United States Public Health Service who shall certify all mental defects or diseases observed. "Medical officers of the United States Public Health Service who have had special training in the diagnosis of insanity and mental defects shall be detailed for duty or employed at all ports of entry designated by the Secretary of Labor." Section 19 provided, that any alien "who within five years after entry becomes a public charge from causes not affirmatively shown to have arisen subsequent to landing" shall, upon warrant of the Secretary of Labor, be taken into custody and deported. The act also made provision for the first time for a literacy test which has been a subject of discussion for years. These amendments are of far-reaching importance and will eventually undoubtedly afford the hospitals considerable relief. The fact still remains, however, that the individual states are expending millions of dollars annually for the care and maintenance of an alien population which should have been excluded by the federal government. Under these circumstances it would seem nothing more than fair that the states should be reimbursed for the cost of carrying a burden for which they are in no way responsible.

CHAPTER X
MENTAL DISEASES AND CRIMINAL RESPONSIBILITY

The question of responsibility for criminal acts, once a legal problem pure and simple, is now recognized as involving sociological, psychological and psychiatric considerations of far-reaching importance. This viewpoint, none too thoroughly established even now, represents the progress of several centuries, and still lacks adequate recognition in law. The eloquent protest against the legal conception of mental diseases written by Isaac Ray[78] in 1838 sounds like a quotation from a recent medical journal. "In all civilized communities, ancient or modern, insanity has been regarded as exempting from the punishment of crime, and vitiating the civil acts of those who are affected with it. The only difficulty, or diversity of opinion, consists in determining who are really insane, in the meaning of the law, which has been content with merely laying down some general principles, and leaving their application to the discretion of the judicial authorities.... It is to be feared, that the principles, laid down on this subject by legal authorities, have received too much of that reverence which is naturally felt for the opinions and practices of our ancestors; and that innovations have been too much regarded, rather as the offspring of new-fangled theories, than of the steady development of medical science. In their zeal to uphold the wisdom of the past, from the fancied desecrations of reformers and theorists, the ministers of the law seem to have forgotten, that, in respect to this subject, the real dignity and respectability of their profession is better upheld, by yielding to the improvements of the times, and thankfully receiving the truth from whatever quarter it may come, than by turning away with blind obstinacy from everything that conflicts with long established maxims and decisions."

A brief reference to the history of the development of the present legal conceptions of criminal responsibility will justify the comments made by Ray. The terms idiocy, lunacy and non compos mentis were all used by Coke in his "Institutes of the Laws of England" written, as nearly as can be determined, in 1625. A differentiation between the significance of the word idiot and non compos mentis appeared as early as 1325 in the English statute "De Praerogativa Regis," which delegated various responsibilities to the crown that are recognized to this day. Sir Matthew Hale, about 1670, described a partial and a total insanity, the former not being accepted as relieving the accused of responsibility for the commitment of a crime. It is an interesting fact that we still hear the question of partial insanity seriously discussed. In 1723 Justice Tracy in a murder trial ruled that "a prisoner in order to be acquitted on the ground of insanity must be a man that is totally deprived of his understanding and memory, and doth not know what he is doing no more than an infant, than a brute or a wild beast." As a result of this ruling a man was found guilty of attempting to murder a neighbor who sent devils and imps into his house at night for the purpose of disturbing his sleep. Fortunately the sentence was commuted to life imprisonment. In 1812 the Attorney General of England[79] ruled that "a man may be deranged in his mind—his intellect may be insufficient for enabling him to conduct the common affairs of life, such as disposing of his property, or judging of the claims which his respective relations have upon him; and if he be so, the administration of the country will take his affairs into their management, and appoint to him trustees; but, at the same time, such a man is not discharged from his responsibility for criminal acts."

The legal procedure of the present day is based very largely on the decisions made at the time of the McNaughton trial in 1843. In this case the Chief Justice, as quoted by Lord Lyndhurst, addressed the following words to the jury: "The point which at last will be submitted to you will be whether or not on the whole of the evidence you have heard you are satisfied that at the time the act was committed, for the commission of which the prisoner stands charged, he had not that competent use of his understanding as not to know what he was doing with respect to the act itself—a wicked and wrong thing—whether he knew it was a wicked and a wrong thing he had done, or that he was not sensible at the time he committed this act that it was contrary to the laws of God and man." This case led to a very serious consideration of the subject in the House of Lords. As the result of an official request for an opinion, the majority of the judges of the court, all concurring but one, expressed the view that "to establish a defense on the ground of insanity, it must be clearly proved that at the time of the committing of the act the accused party was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or if he did know it (sic) that he did not know he was doing what was wrong."[80]

The importance and significance of these decisions, which one might very readily assume to be obsolete and too ancient to be worthy of consideration, will be made clear by a quotation from the penal code in effect in New York today. "Sec. 1120 (Penal Law). Incompetency of idiot or lunatic. An act done by a person who is an idiot, imbecile, lunatic or insane is not a crime. A person cannot be tried, sentenced to any punishment or punished for a crime while he is in a state of idiocy, imbecility, lunacy or insanity so as to be incapable of understanding the proceeding or making his defense. A person is not excused from criminal liability as an idiot, imbecile, lunatic or insane person except upon proof that, at the time of committing the alleged insane act, he was laboring under such a defect of reason as 1, not to know the nature and quality of the act he was doing; or 2, not to know that the act was wrong." It will, I think, be conceded that we have, at least, not lost ground in any way since 1843.

No less interesting is the legal definition of insanity in Massachusetts: "The words 'insane person' and 'lunatic' shall include every idiot, non compos, lunatic and insane and distracted person." (Chapter 4, Sec. 7, General Laws of Massachusetts.) In New York the terms lunatic and lunacy include every kind of unsoundness of mind except idiocy. (Chapter 22, Sec. 28, Consolidated Laws.) This would presumably include psychopathic personality and imbecility.

Numerous court decisions have had a material bearing on the subject of responsibility. It has been held in New York that partial or incipient insanity is not a sufficient defense if there is still an ability to form a correct perception of the legal quality of the act and to know that it was wrong. (People vs. Taylor, 138 N. Y. 398, 407 (1893)). A weak or disordered mind is not excused from the consequences of crime. (People vs. Burgess, 153 N. Y. 561, 569 (1897)), etc. Generally speaking, the legal methods of determining criminal responsibility do not vary to any material extent with the different states. It is obvious that the responsibility for crime as defined by the courts is far from harmonizing with the conception of competency entertained by the medical profession. To the psychiatrist, if the criminal act is the result of the mental condition it constitutes a symptom of the disease process. It is readily apparent from even a very brief reference to the statutes that a person concededly suffering from paranoia, general paresis, dementia praecox or any other well-defined psychosis is still criminally liable for his insane acts within certain limitations. From a medical point of view the existence of a psychosis, if associated with a consequent judgment defect, emotional instability, disturbance of volition, intellectual deterioration, delusional and particularly persecutory control, hallucinatory trends, ideas of reference, etc., is of itself quite sufficient to explain criminal acts in the insane. This, however, as has been shown, is not the legal point of view. The accused is fully responsible unless it can be shown that he is suffering from such a defect of reason as not to appreciate the quality or nature of his act or that the act is wrong. There is no other legal standard. It is a well-known fact that many persons adjudged insane by the courts and committed to our institutions are fully competent to discriminate between right and wrong from an ethical point of view, although legally held to be incompetent and unsafe to be at large. These divergent viewpoints presumably are due to the fact that the law moves only with a degree of dignity which theoretically guarantees absolute security in avoiding any possible sources of error. It nevertheless is responsible for many miscarriages of justice.