589

THE LANCET.

LONDON: SATURDAY, JUNE 9, 1855.

THE PSEUDO-MEDICAL EVIDENCE UPON WHICH BURANELLI, A MADMAN, WAS HANGED.

WERE it simply our object to expose the medical evidence forthe prosecution, in the case of BURANELLI, to the condemnationof the medical profession, and, indeed, of every man of clear-

sightedness enough to distinguish plain facts and intelligiblepropositions from wild assumptions, arbitrary dogmas, andmystical nonsense, we should content ourselves with giving averbatim report of the pseudo-scientific testimony of its authors.Thus would that object be fully attained. Not a word of

elucidation or comment would be required to point out theperverse blindness to facts, the marvellous inconsistency, theutter irrelevancy that characterize that evidence. But our

design is very far above all care for personal opinions. Dr. MAYOmay continue to hold communion with ghosts, to "project" hismind from his body, to study the growth of metaphysical" parasites," or to indulge in any other " adventurous specula-tions" that he pleases; Dr. SUTHERLAND may split hairs to thefullest extent of capillary subdivisibility; he may pronouncedelusions to be illusions, and even discover in his stomach thefunctions that in other men reside in the brain. That is no

Iconcern of ours, at least so long as Drs. MAYO and SUTHERLAND ’,

confine their mystical reveries and transcendental physiologyto the closet. But when men holding such opinions are sum-moned from the realms of dream-land by the authority ofGovernment, to guide the administration of criminal justice-when we find that their theories are eagerly accepted by judges,juries, and Secretaries of State, as the expression of the prin-ciples of medical science, and applied without remorse, and indefiance of irrefragable evidence, to the hanging of a madman,it is surely time to interpose in order to rescue medicine fromcontempt, and the law from execration.We apply ourselves, therefore, again to the imperative but

unwelcome task of sifting to the utmost the evidence selectedby the Crown, in order to establish the sanity of BURANELLI,and to warrant his execution.

We shall ask, in the first place, whether that evidence be

really based upon the facts established at the trial; secondly,whether the facts assumed, being true or false, the reasoningapplied, and the conclusions deduced, be in accordance withthe rules of science and justice ; and thirdly, whether the evi-dence for the prosecution, bore upon the question before the jury ?The facts forthe prisoner were numerous and striking, and there

was no attempt to rebut them. It was shewn that prior to thedeath of his wife, about three years ago, BuRANELLi had beenremarkable for his mild, cheerful, inoffensive disposition andconduct. It was shown that from that epoch his characterunderwent a total change; he became moody, melancholy,oppressed with suicidal thoughts, incapable of application tohis customary employments, an object of compassion to theinhabitants of the village in which he dwelt. It was shown

that, suffering from a fistula in ano of trifling nature, he wascured by a slight operation; that this malady, and the con-sequent operation, became the groundwork of the most fantasticdelusions; that he entertained the belief that the surgeon who

had cured him was his deadly enemy; that he believed that hillurine flowed constantly from the seat of his former malady, andin such copious streams as to swamp his bed; that so rootedwas this belief, that neither argument nor repeated physicaldemonstration of its absurdity could shake it. It was provedthat from having been remarkable for his quickness and intel-ligence, he had become dull, incapable of maintaining a con-tinued train of thought; that his language, spoken and written,was marked by disorder and incoherence, and his deportmentand actions wild and fitful, and impressing upon those who sawhim daily, the conviction that he was insane. These are the

leading facts, although by no means all, that were proved onthe trial. No conclusions as to the mental condition of BURA-

NELLI before and at the time of the homicide for which he wastried, unless based upon these facts, can be of value. All

conclusions based upon the principle of ignoring these facts,and assuming other facts that were not proved, must be purelyarbitrary and beside the question at issue.And how did Mr. MACKMURDO, Drs. MAyo and SUTHERLAND

deal with these facts ? The greater part they disregarded alto-gether ; the rest they grossly perverted from their true cha-

character and significancy, by conjuring up other facts whichwere not in evidence and which existed only by conjecture.Thus we find Mr. MACKMURDO, Drs. MAYO and SUTHERLAND

assuming as a fact, that at the time when BURANELLI wasunder medical observation in the Middlesex Hospital, the

fistula was imperfectly healed, that a fluid discharge reallyescaped, which, exaggerated by the patient, accounted for thedelusion that his urine flowed in such a copious stream as todeluge his bed! We find Mr. MACKMURDO asserting, thathaving examined BURANELLI a short time before the trial, andmonths after the period of the delusion, that there were still

slight remains of the fistula; and we find Drs. MAYO andSUTHERLAND taking up this fact, which, if true, was without

importance, as being out of date, and by an arbitrary violationof common sense, assuming that the vestiges seen by Mr.MACKMURDO had existed all along from the time of the opera-tion by Dr. BALLER. They did not stop to reflect that Mr.MACKMURDO could only speak to the condition of the man atthe moment of his observation; they had the presumption todiscredit the positive, distinct, and unshaken testimony of Mr.MITCHELL HENRY, that when the delusion was in full force,the fistula was absolutely cured, and that there was no

discharge, no fluid whatever to warrant the belief that hisurine flowed from the spot, and deluged the bed!We further find that Mr. MACKMURDO, seeking for a resting-

place for his conclusion that BURANELLI’S belief in the escapeof fluid from his person was an exaggeration, and not a crea-tion, by assuming two other facts, which had not a tittle of evi-dence to support them. He takes the assertion of BURANELLI,that he had passed blood, without proof that he did pass it,and then assumes that the visionary blood issued from internal

piles, which Mr. MACKMURDO might have seen or felt had

they existed, but which he did not see or feel, and which Mr.HENRY had declared from actual observation did not exist!

The real and indisputable facts deposed to by Mr. HENRY, as

existing before and up to the day of the homicidal act, werethrown aside by the medical witnesses for the prosecution, andother facts illusory in themselves, and inadmissible as to time,are substituted as the basis of their metaphysical speculations.Let us now test the scientific value of these speculations

590 THE PSEUDO-MEDICAL EVIDENCE UPON WHICH BURANELLI, A MADMAN, WAS HANGED.

that resulted in consigning BURANELLI to the gallows.Although, indeed, since the conclusions of Mr. MACKMURDO,Drs. MAYO and SUTHERLAND, were built upon illusory andmistimed facts, their evidence was necessarily but a tissue offallacies, a senseless anachronism, it is not the less important,bearing in mind the end we have in view in prosecuting theanalysis.Taking the facts proved in evidence, that the fistula was

perfectly healed, that no fluid beyond the natural perspirationexisted in the spot whence BURANELLI believed that his urineflowed in a copious stream, we presume that no one will dis-pute that this belief was as clearly an insane delusion as everwas created in the brain of a madman. But say Drs. MAYO and

SUTHERLAND, there was a little morbid moisture in the part; .BURANELLI was hypochondriacal, and when he exaggerated a"little oozing" into those floods of water which swamped hisbed, he was exhibiting not a delusion, but an illusion, and anillusion according to them is quite consistent with soundnessof mind. We will therefore take the case, albeit not BupA-

NELLI’S case, as they state it. By all means let us understandif we can how they distinguish an illusion from a delusion." An illusion is objective," says Dr. SUTHERLAND ; " a delusionis subjective, but the judgment must be involved.’’ Now we,

in the first place, say that the distinction, in as far as it pre-tends to be a discriminative test between sanity and insanity,is untenable, absurd, and contrary to the current teaching ofall those who have a right to the title of scientific and practicalpsychologists. There is nothing better established than thateven delusion, per se, is no test of insanity at all. It mayexist in the sound mind, and be absent from tha unsound.

Physicians discuss the characters of a delusion, not so muchwith the object of determining whether the individual bereally labouring under a delusion or not, but as a means offurther studying and gauging the integrity of his mental facul-ties. They seek to determine how the individual in his judg-ment and volition deals with his delusion. If by judgment hecan discover the incongruousness of his belief, and if by hiswill he can emancipate his mind from its control, and keep hisactions free from its suggestions, he is sane. If judgment andvolition are so much at fault that he can do neither, the manis mad, and, being mad, the responsibility for his actions mustnot rest with him, but with society, which ought by timelyintervention to have prevented their occurrence.But since great errors and very vague ideas prevail amongst

lawyers and the general public concerning the nature anddiagnostic value of delusions, we will endeavour to state

clearly in what delusion consists, and what are the conditionsof mind that must be present to constitute insanity. It would

be an unprofitable task to analyze the various definitions ofdelusion that have been given by medical and legal authors.Many are imperfect. But we believe the fundamental idea in

most minds was essentially the same, although there has been

great diversity in the power and felicity of expression. The

matter is most lucidly set forth by ESQUIROL.

"There are insane persons, who believe that they see, hear,feel, taste, and touch, whilst external objects are beyond thereach of their senses. This symptom is can intellectual cerebralphenomenon the senses go for nothing in its production."

This kind of delusion is properly called hallucination. To

believe that you can divorce your mind from your body, that

your mental entity is careering through the realms of space,

that you are surveying a new world, a metaphysical flora,parasitical growths feeding upon your mental entity, but

without substance, and unknown to ordinary men, is to be ina state of hallucination. This state is purely cerebral andpersonal, or, as metaphysicians say, subjective.

" In illusion, on the other hand, the sensibility of the nervousextremities is altered, either by exaltation, enfeeblement, orperversion; the senses are active; actual impressions excite thereaction of the brain. Illusions are not rare in a state ofhealth, but reason dissipates them. A square tower, seen

from a distance, appears round; approached, the error isrectified. Hypochondriacs have illusions which arise from theinternal senses. They deceive themselves as to the intensityof their sufferings, or the danger of losing their lives, but neverdo they attribute their ills to causes repugnant to reason; they donot reason falsely, unless lypemania (melancholia) complicatethe hypochondriasis. Then there is delirium; hypochondriacalthe hypochondriasis. Then there is delirium; hypochondriacallypemaniacs have illusions and reason falsely concerning thenature, causes, and symptoms of their diseases."

Neither in the case, then, of the subjective hallucination orof the objective illusion, is it the hullucination or the illusion,per se, that is proof of insanity. In both cases it is in the

cerebral reaction, the judgment and the volitional power in

dealing with the hallucination or illusion, that we must seekfor the proof of sanity or insanity. In this country, we takethe opportunity of observing, hallucination and illusion are

generally confounded together under the common name of de-lusion. Let us apply this to the MAYO-SUTHERLAND view ofthe facts in the case of BURANELLI. Assume that the unhappyman did throughout retain such a remnant of his fistula as to

yield moisture enough to wet a piece of lint worn on the part;- assume that he exaggerated, not created; that out of a fewdrops of moisture he conjured up torrents of urine that

deluged his bed. Is this a mere objective illusion such as isconsistent with the course of simple hypochondriasis ? Let it

be remembered that BURANELLI reasoned falsely, most grossly,and in defiance of Mr. HENRY’S practical demonstration of the

integrity of his urinary passages by passing a’catheter intohis bladder. The lunatic converted a few drops of perspira-tion into floods of urine. He, therefore, reasoned falsely as to thenature and symptoms of his malady. He was suffering undermelancholia-and here we must applaud the correct use Dr.BALLER made of this word, a use quite in accordance withthe facts of the case, and the scientific definition of EsQurROL- in addition to hypochondriasis. BuRANELLIwas the subject ofillusions altogether repugnant to reason-illusions not merelyobjective, because he believed his sheets were deluged withurine; but subjective, because the dry sheets held before his

eyes, and made to touch his person, still found his brain un-

able to react healthily, his judgment unable to correct the

error conveyed by his diseased sensation, his will unable tosubdue the influence of a belief demonstrated over and over

again to be absurd.Testing, then, the mental integrity of BURANELLI, not

merely by the existence of illusions objective or subjective,but by his power of reacting against those illusions, was he notmad ? What medical practitioner would have hesitated beforethe homicide to sign a certificate for his confinement in an

asylum? Is it not a mere play upon words, a shocking jugglerywith common sense, to say that BURANELLI was labouring notunder a delusion, but an illusion, and to hang him upon a

syllabic quibble, upon a distinction that had no existence ?We have thus shown sufficiently, although we have by no

means exhausted the proofs, that the evidence of Mr. MACK-

591COMPLETION OF MR. SYME’S CLINICAL LECTURES.

MURDO, Drs. MAYO and SUTHERLAND, was, in the first place, to be their duty. We do not doubt that they were actuatedbuilt upon gratuitous assumptions of facts not in evidence, by a stern determination to arrest what they conscientiouslyand disregard of facts actually proved; that it was, in the second believed to be a growing disposition on the part of medicalplace, inconsistent in itself, at variance with the physiology practitioners to urge, and of juries to accept, the plea of in.and pathology of the age, and at best but of a pseudo- scientific sanity improperly. But we solemnly warn them that theycharacter. Having done this, we think it needless to do more have chosen for their point of resistance a position that neitherthan repeat the third point of our objections to this evidence, science will sanction, justice approve, nor humanity tolerate.In our last number we showed that the whole observation and They have deliberately set at nought the merciful spirit ofthe whole structure of the conclusions of these gentlemen re- English law as well as of natural justice. In seeking to pre-ferred to that period of BURANELLI’S life after the homicide, serve intact the principle of responsibility to society againstafter the recovery from his suicidal wound, that is, to a period the improper use of the plea of unsoundness of mind, they havewhich had no relation whatever to the question before the done what one case can do to found a precedent, that not onlyjury, which was as to the sanity or insanity of BURANELLI are the sane responsible for their actions, but the insane also.anterior to and at the time of the homicide. The evidence of They have taken their stand upon the slaughtered, but yet.Dr. BALLER, Mr. HENRY, and Mr. SHAW, of his unsoundness of appealing, corpse of a madman.mind at that time remains unshaken and conclusive beyond The exertions made by Mr. AIITCHELL HENRY to prevent thecontroversy. Dr. SUTHERLAND did not even dare to call it in execution of the miserable lunatic are beyond all praise. His

question. He evaded all reply to the question as to the state mind will retain a happy recollection of his humane efforts toof BURANELLI’S mind at the time of the homicide. the last day of his life, nor will they soon be forgotten by theWe have but a few words more to offer before we dismiss intelligent portion of the public.

this painful task. Dr. SUTHERLAND believed, and as it is

beside the question at issue, we have not disputed the justice LAST week we completed the publication of the winter

of the grounds of his belief, that BURANELLI was of sound course of Clinical Lectures in Surgery delivered by Mr. SYMEmind when seen by himself the day before the trial. He in the Royal Infirmary of Edinburgh. We cannot close thistold the jury that he had observed no symptom of aberration course without briefly referring to the Lectures and to theirof mind. Be it so; but what was his state of mind on the 7th distinguished author. The publication has extended over fiveof January, the day of the fatal deed ? Dr. SUTHERLAND months, during which we have been enabled to publish twenty-could not know; when asked upon his oath for his opinion, he two Lectures on the more important points of surgery withoutdeclined to answer. If he had an opinion at that time, the a single break or intermission. Of the surgical value of thesetime of the trial, was he not bound to give it ? 9 Is his plea contributions to the difficult and important subject of clinicalthat that was a question for the jury, " not for him," to decide, surgery there has been but one opinion in this country. The

a valid excuse? Admit that it was, and then judge of what excellent method of treating surgery adopted in the Universityfollows. After the sentence, as is well known, such efforts as of Edinburgh has been demonstrated, and all must regret thata conviction of the insanity of BURANELLI rendered it an im- in no other British school whatever does there exist a real and

perative duty to make were made in order to stay the execu- practical Professorship of Clinical Surgery. In all the greattion. Dr. SUTHERLAND was waited upon for the purpose of London schools clinical lectures in surgery are given, but wemaking him acquainted with many facts in the case of which have no instance of a man of high position, like Mr. SYME,he was ignorant, and particularly with the suppressed testimony entirely trusting his reputation, and devoting his talents withof Mr. SHAW. He was asked to write a note to the Secretary energy and enthusiasm, to the subject of clinical surgery. In

of State, and to say that in his opinion Mr. SHAw’s evidence Mr. SurE’s hands this department has become a great featurewas important, and ought to have been laid before the jury, in the curriculum of the University of Edinburgh, and one ofand that he did not think the case entirely free from doubt. the most powerful means of instruction adopted in that im-

Dr. SUTHERLAND contemptuously disregarded the direct portant school. In no department can it so truly be said thattestimony, not only of Mr. SHAW, but the conclusive opinions the teacher is himself taught as in that of clinical instruction.of two such men as Drs. CONOLLY and WINSLOW,-in opposing Nothing can more powerfully stimulate a man of ability towhom temerity itself would hesitate,-and saying the case was become a great practitioner, and to advance medical andfreefrom doubt, refused to do anything further in the matter! surgical knowledge, than the ever-present knowledge that in

Contrast this declaration with his answer to the jury. Be- all his more important cases he must reproduce the history offore the jury he declined to offer an opinion as to the state of the case and its treatment, and review himself, as it were, inthe prisoner’s mind at the time of the homicide; after the sen- the presence of students and practitioners, who have watchedtence, he in effect pronounced the most decided opinion that his proceedings from day to day. No doubt Mr. SYME must

the prisoner was of sound mind at the time in question-a time himself owe much to his habits as a clinical teacher, and the

beyond the period of his own observation; and thus BURANELLI profession must have seen, in the course of the lectures we havewas hanged ! , recently concluded, how many of the modern improvements of

If Governments and those entrusted with the conduct of surgery are due, in whole or in part, to this distinguishedcriminal prosecutions should haply be led to reflect upon the surgeon.

many questionable features of this melancholy history, we fer- We believe that in the publication of this course of lecturesvently trust they may discover in it, not a precedent to imitate, we have conferred a benefit upon the profession at large, andbut a fearful error to be shunned in the future. We cheerfully supplied the stimulus of a new emulation to the teachers andrecognise in the conduct of those who are responsible for this surgeons of this metropolis. It cannot but do good to have theunnatural execution the desire to discharge what they conceived opportunity afforded us of measuring ourselves by the standards

592 THE MEDICAL BILL OF THE PROVINCIAL MEDICAL AND SLTRGICAL ASSOCIATION.

adopted in other schools. The result must be that a higherestimate will be formed of Mr. SYME’S abilities by surgeons onthis side of the Tweed, and that Mr. SYME will feel himself

less belonging to the chief medical school of Scotland than tothe great community of British schools which adorn the British ’’,

empire. Prejudices of and for local matters cannot fail to be rubbed down by the intercourse of constant publication. We ’’ihave not too many great men, and the more they are known I,the more they will be valued by the profession. We are no

hero-worshippers. Minor criticisms must disappear in the ’,case of men fitted not only to uphold the practice of their pro- fession in their own day and generation, but to hand it on withimprovement and progress to those who come after them.

These are the men the profession should admire and support,not the men of practice without progress, or of progress withoutpractice, if the latter, indeed, be possible. The presentcriticism of our leaders, in which we are all engaged, does not ’,stop short with the commanders of our armies, and our govern- ments at home. In all professions and conditions of life men are asking themselves if the right men are in the right places-if mere prestige and accident hold the rank which should be

given of right to talent and industry. This is a time when all

men of high position are especially called upon to show therights and titles by which they hold or assume superiority. Few,we believe, will refuse the application of these remarks to themedical profession. If Mr. SYME has shown himself at times

unflinching and unbending, all must have perceived with

respect that it was when he believed himself to be opposingthe wrong and upholding the right. We are sure, in thus

observing upon the termination of Mr. SYME’s connexion withour readers for the present, that we can say, with perfecttruth, that whenever this celebrated surgeon may wish toaddress the profession throughout the civilized world, his com-munications are certain to attract universal attention.

ANALYSISOF

THE MEDICAL BILL OF THE PROVINCIALMEDICAL & SURGICAL ASSOCIATION.

(THis Bill was printed last year. It has lately been sub-mitted to the Home Secretary, who has forwarded copies tothe Universities and Medical Corporations, requesting the

opinions of the governing authorities upon its provisions. The

opinion of the Glasgow Faculty in favour of the Bill we pub-lished on the 19th ult. The opinion of the Senate of theUniversity of London is not made public, but we are informedthat it is adverse. We now submit it to the judgment of theprofession.)

__

Clauses I., IL, III., & IV. are of a formal character, re-

ferring to the repeal of Acts and definitions of terms.A MEDICAL COUNCIL.

V. Medical Council.-A Council shall be established, whichshall be styled " the Medical Council," and shall consist of onephysician and one surgeon, to be chosen from time to time bythe Colleges of Physicians and Surgeons of England respectively,one physician and one surgeon to be chosen from time to timeby the Colleges of Physicians and Surgeons of Edinburgh re-spectively, one physician or one surgeon to be chosen from timeto time by the Faculty of Physicians and Surgeon. of Glasgow,one physician and one surgeon to be chosen from time to timeby the Colleges of Physicians and Surgeons of Ireland respec- tively, one person to be chosen from time to time by the Uni_

versities of Oxford and Cambridge collectively, one person to bechosen from time to time by the University of London, oneperson to be chosen from time to time by the Universities ofEdinburgh, Glasgow, Aberdeen, and St. Andrew’s collectively,one person to be chosen by the University of Dublin and theQueen’s University in Ireland collectively, and eight persons tobe elected as hereinafter provided, and hereinafter called "theRepresentative members:" the first of each of the said appoint-ments by the said Colleges and the said Universities to be madewithin three months after the passing of this Act.

VI. Tenure of Office by Members chosen by the Colleges.-Every member of the Medical Council chosen by the saidseveral Colleges of Physicians and Surgeons, by the saidFaculty, and the said Universities, shall be entitled to holdoffice for three years, and shall then go out of office, but mayforthwith be re-chosen.

VII. Appointment of Members of First Council.-TheSecretary of State for the Home Department shall, withinthree months after the passing of this Act, appoint eightpersons qualified to be registered under this Act to be theeight members of the First Medical Council not chosen by thesaid several Colleges of Physicians and Surgeons, or by thesaid Faculty, or by the said Universities, four of such personsto be appointed for England, two for Scotland, and two forIreland; and the said eight members of the First MedicalCouncil shall hold office till the fir°st day of June, one thousandeight hundred and fifty- , and shall then go out of office.

VIII. Election of Representative Members.-On the first dayof June, one thousand eight hundred andffty- , and on thefirst day of June in every third succeeding year, the eight re-presentative members of the Medical Council shall be electedin the manner hereinafter provided; four of such representa-tive members to be elected by those persons whose names shallappear in the last printed Medical Register, to be publishedas hereinafter provided, as registered for England; two of suchrepresentative members to be elected by those persons whosenames shall appear in the like Medical Register as registeredfor Scotland; and two of such representative members to beelected by those persons whose names shall appear in the likeMedical Register as registered for Ireland; and each of thesaid representative members shall remain in office for three

years, and shall then go out of office, but may forthwith be re-elected.

IX. Candidates for Council to be nominated.-At any timenot less than forty clear days next previous to the day of everyelection of representative members of the Medical Council forEngland, Scotland, or Ireland respectively, any person entitledto vote at such election may give or transmit to the MedicalRegistrar, to be appointed as hereinafter to be provided, apaper, according to the form in Schedule (B) No. 1, signedby not less than twenty persons entitled to vote at such elec-tion, containing the name of any person they may think fit tobe elected as a representative member at the then ensuingelection; and the Medical Registrar shall cause all such namesso given or transmitted for England, Scotland, or Ireland re-spectively, to be printed, together with the names of the per-sons recommending the same, and shall also cause the namesof the representative members for England, Scotland, or Ire-land respectively, then going out of office, to be printed, in therespective voting papers to be used at the said election, andsuch persons so nominated shall be the only persons eligible tobe elected representative members for England, Scotland, orIreland respectively, on the day of election.

X. & XI. Provide for place of election, and the method ofvoting at elections. Votes may be transmitted by the post.

XII. Defines the method of declaring the result of elections.XIII. Appoints two members of Council to superintend

elections.XIV. Provides for the appointment of members of Council,

in event of vacancy.XV. Provides for payment of "reasonable fees" for attend-

ance and travelling expenses to Council.XVI. Defines time and place of meeting.XVII. Directs appointment of officers.

PRELIMINARY CLASSICAL EXAMINATION.

XVIII. The Medical Council shall, within three months aftertheir first meeting, appoint Examiners in London, Edinburgh,and Dublin respectively to examine in Classics and GeneralLiterature, after a scheme to be approved by the MedicalCouncil; and such examiners shall receive such remunerationas the Medical Council shall think fit, and shall hold office forsuch period as the Medical Council shall determine; and no