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Source: Kansas City Medical Index-Lancet
Source type: journal
Document type: article
Document title: “Epilepsy, Responsibility and the Czolgosz Case”
Author(s): Christison, J. Sanderson
Date of publication: January 1902
Volume number: 23
Issue number: 1
Pagination: 10-17

Christison, J. Sanderson. “Epilepsy, Responsibility and the Czolgosz Case.” Kansas City Medical Index-Lancet Jan. 1902 v23n1: pp. 10-17.
full text
epilepsy; Leon Czolgosz (mental health); Leon Czolgosz (psychiatric examination: criticism); assassins (mental health).
Named persons
Pietro Acciarito; John Baker (b); L. J. Czechowski; Leon Czolgosz; Julius Donath; Charles Féré; Cayetano Galeote Cotilla; William Gowers; John Hughlings Jackson [misspelled once below]; William McKinley; Giovanni Passannante; Emmanuel Régis; J. Russell Reynolds; Ernst Christoph August von der Sahla; Samuel Wilks [misspelled below].
The identity of Berardi (below) cannot be determined. Possibly it is Filippo Berardi, a victim of assassination (i.e., not an assassin himself).

From page 10: J. Sanderson Christison, M. D., Chicago, Ill.


Epilepsy, Responsibility and the Czolgosz Case

     I define epilepsy as a more or less transient and spasmodic affection of the psychic functions, with or without motor or sensory manifestations.
     There is a more or less sudden and unaccountable break in the continuity of the conscious mental activities of the subject, so that cases of muscular spasm or tremor, as in tetanus, chorea, etc., in which there exists no apparent aberration of consciousness, are excluded from this category. And yet a mental factor presumably exists in all convulsive cases, since when mind has departed, as in death, by shock, even electricity almost immediately fails to produce a reaction.
     Dr. Russell Reynolds has defined the essentials of epilepsy as a diminution of intelligence and muscular spasm. But muscular spasm, as it is usually known, is not a constant condition, while psychic aberration is. Dr. Baker, of the Broadmoon [sic] Criminal Lunatic Asylum, regards loss of consciousness as the pathognomonic sign of epilepsy, (1) while Dr. Wilkes, of Guy’s Hospital, relates several cases in which coma was the only symptom, and one case in which automatism alone existed (2). Many similar cases can be cited. But there is no dispute that in some cases the psychic manifestations exist alone, while in other cases convulsions with simple loss of consciousness are practically all the phenomena observed. These two main forms or aspects of epilepsy often alternate in the same person, either speedily or after considerable intervals, even months or years. But whether it is mind or muscle that gives expression to the malady, the manifestation is essentially a form of spasm, inasmuch as there is a more or less sudden interruption of the subject’s normal currents of vitality and intelligence. Dr. Hughlings-Jackson has curtly described these convulsions as a brutish development of many of the subject’s ordinary movements, and the description is quite as appropriate to psychic cases, although not in any reversion sense.
     The sensory perversions in epilepsy exist either during loss of consciousness or are manifested by some kind of hallucination during one of the stages of a fit. Common sensation is usually diminished.
     It is evident to most thoughtful observers that epilepsy is manifested by a great variety of conditions extending all the way from a momentary lapse of thought, or a vertige, or a simple automatism, to the condition of violent mania or clonic convulsions. The petty varieties seem to bear much the same relationship to the sthenic forms that a trickle does to a flood, or a whiff to a tornado; while the equation in epilepsy is, of course, more complex. Drs. Gowers, Fere, and Hughling-Jackson find that there are as many epilepsies as there are epileptics.
     The modern theory of the origin of a fit places it in the gray matter of the brain, i. e., the cortex cerebri, more or less of which is supposedly surcharged with nervous energy, whatever that may be. But there seems to be no substantial support for such a view, for we do not know that any organic cell can store anything in the way of excessive cargo. A morbid cell is a functionally defective cell, while a cell functioning normally is an orderly agent, whatever its degree of activity may be, and cannot be conceived as reserving anything for a sort of whimsical flash, which must necessarily disturb its own integrity. Even the discharged energy of the gymnotus electricus is not a surplussage but the product of a conservative provision, in natural economy. That during a cell’s activity its energy can be raised or lowered within certain limits, according to whether it is well or ill favored, is not questioned, and thus its power of resistance to certain irritants, or its capacity to respond to certain exactions, will vary with altered conditions, i. e., with its supply and demand of [10][11] means for energizing. There may exist an excessive sensitiveness or activity in brain cells in epilepsy, or the inhibatory [sic] relations may be disturbed, owing to defects in the nerve cells of the brain, i. e., the cortical neurons and their branches, which defects may impair connection and thus increase resistance. But all such views are merely speculative, as indeed is the case regarding the pathology of other insanities, for in a considerable proportion of all so-called idiopathic forms of insanity, the brain shows nothing whatever that can be described as abnormal. Thus it is evident that lesions found in cases which are not produced by mechanical violence can only be regarded as mere casualties or products and not as causative factors. Indeed those occasional cases of insanity of many years standing, but which finally recover in a more or less sudden manner, quite disprove the necessity for any organic pathological correlative. And to this we may also add the evidence of the many recorded cases of extensive and destructive brain lesions existing without any mental manifestations whatever of a distinctly aberrant character. Epilepsy is indeed frequently associated with gross lesions of some kind, the removal or mitigation of which is sometimes, but quite seldom, followed by relief from the epilepsy. Such recoveries are probably due to what may be termed an accidental alteration of functional balance, or some form of sympathetic readjustment. At all events, we must look for a form of functional perversion irrespective of any organic disease. Nor is it necessarily a brain disease any more than fainting or vertigo are, without denying that the brain takes a part in the act. A physical shock or mental shock may cause any of them. For example, a blow on the stomach, or a fright; while in monkeys a trifling intravenous injection of absinthe will produce epileptic fits without exception. (3) It is said that practically the same result takes place in man. Dr. Julius Donath produced epilepsy in animals at will by stimulating the cervical sympathetic, while if the sympathetic was cut no fits could be produced (4). Yet removal of the superior cervical ganglia from both sides of three epileptic patients did not affect their fits. And lastly, the observations that chickens hatched by incubators and squirrels and various other creatures deprived of their liberty almost invariably become subject of epilepsy, go to show how slight a variation in the tempering of the mental nexus is required to permit a disjointing, so to speak, of the associative processes. They also indicate that the essential element in epilepsy is a psychic defect, whether it be appreciable or not, for it is to be noted that the chickens referred to have no natural mother, while the other creatures have lost their natural home or environment, while their food and other conditions are about the same as in normal cases. These are observations worthy of farther reflection. It is therefore evident that the problem of epilepsy is essentially one of physiologic psychology.


     Epilepsy occurs everywhere from the top to the bottom of society. It afflicts the saint, the sage and the sinner alike and even the infant in the cradle, so that it cannot be charged as an evil for which the subject is in any way necessarily responsible, since it may arise under conditions for which the subject could in no way be responsible. Of course evils cannot arise when strictly normal conditions exist within and without, for the simple reason that everything must have an efficient cause, so that if we seek for originating causes we must carry our analysis into the realms of heredity, tradition and moral and intellectual environment.
     But in facing the question of personal responsibility it is sufficient to define epilepsy as essentially being an abnormal mental state for which the individual is not responsible because its origin is spontaneous and is not a matter of choice. I do not mean to say that conditions preventable by the subject are [11][12] not at times contributory causes. But this point is not legally available, inasmuch as its decision depends upon the subject’s private personal experience and even if admitted, the elements of heredity and environment could be pleaded as complications and predisposing factors and, most likely, the sine qua non of the case.
     At this point just a word regarding the principle of responsibility. We are responsible creatures only in so far as we possess the powers of discernment and choice, i. e., if we have the power to know correctly and also the privilege of knowing to an extent equal to our needs both in regard to ourselves and our social duties and in addition if we possess the power of choosing equal to our needs and social relations, then indeed we are responsible, i. e., we are competent to respond to the requirements of any position we are rightfully placed in. In other words, we must in some way be co-ordinate and co-equal to the conditions required, else we simply cannot comply with them, so that justice cannot exact by a standard that is any higher than the factors which the heredity and history of the individual can furnish for a formula of conduct. Thus the standard of justice is no more and no less than the standard of the individual subject. It is quite evident that we must know right before we can do right in the sense of a moral obligation. While it is also a well known fact that we may know the right and not be able to do it. If either of these factors, which are the prerequisites for responsibility, be absent or defective, responsibility is correspondingly impaired. Even the knowledge of right and wrong either in the absolute or relative sense in any given case is not proof of responsibility, for often where the knowledge exists the power to choose that which is clearly right may be lost through the cumulative effect of habits or conditions which the subject may have been led or driven into, or perhaps by some kind of seizure or sickness quite as inexplicable as is the origin of epilepsy. Witness especially some of the strange and even horrid practices of certain alien peoples or the marked change of character in some of our own friends which occasionally follows acute ailments.
     But psychologically and theologically speaking, responsibility, as a qualification implying the liability to receive punishment in the operation of justice, cannot possibly exist unless the individual is conscious of ill desert, and this consciousness must not be a vague feeling arising from the imagination, which indeed, it frequently is, but it must come as a clear cut conclusion drawn from first principles, i. e., the knowledge drawn from common experience applied to the special circumstances of the case, in order that justice as a process of retribution shall be properly effected. But retributive justice is infinitely beyond man’s power of administration and a discussion of it here is beyond the scope of this paper. However, I think I have suggested how sadly unjust are our present legal methods which operate in the name of justice—using, as a rule, but one standard, and, as a rule, applying but one method of treatment, and that a brutish penalty.
     But back to our subject in its medical aspect. A perverted state of mind is a state of mind which more or less incapacitates the subject for acting in a proper, efficient or normal way. He is not himself, so to speak, and he can’t help it, for the time being, at least. Normally his conduct is presumably representative of the society in which he has lived prior to maturity and is regulated by general principles, common experience, inculcated precepts, prevailing sentiments, common usages and every-day habits. But when his mind is involuntarily thrown into an abnormal condition through external and internal conditions which he could not control and did not create, his ordinary character qualities lose their inhibitory power over what he would normally regard as wrong-doing. In this condition he may be dominated by [12][13] notions which are in their nature wrong or by feelings which are in degree excessive. He may still in a measure be amenable to discipline, such as threats and kindness, a fact which only goes to show that his perceptive powers have not been annihilated but are, in certain aspects at least, weakened and aberrant. Usually (excluding stupor and delirious mania) there are certain lines of thought that become distorted through some undue influence, perhaps both physical and mental, and which deprive the subject of self control. The chief psychological fault is an imperfect range of his mental vision, a sort of fragmentary perceptiveness, owing to breaks in the individual’s associative processes. Thus the power of the subject as a free agent to respond in a proper way to the standards of society, is crippled or destroyed because the faculties of spontaneous and voluntary association of ideas along pre-established lines are damaged or destroyed. Such breaks may render him abnormally suggestable [sic] and keen in certain directions and correspondingly obtuse in other directions, so that a condition of unbridled impulse may arise through a flock of ideas coming to the front which have been either checked or dispersed by his common normal habits of thought, the very regulators of ordinary social circumspection. The ordinary monitors of the mind are thus thrown out of their normal relations, are devitalized, so to speak, and rendered inoperative as factors inhibitory to wrong doing and thereby the individual has lost his responsibility because the factors which give and constitute responsibility in any true sense, now fail to respond to the very calls which in the subject’s normal state would have been effective. The light from the lamp of reason has become more or less eclipsed or obscured by an alien and fortuitous agency for which no one as yet has been able to account, and therefore is in no sense a product of the subject’s choice. To hold such a person responsible for a crime would be just as reasonable as to demand that an old-time swimmer who has lost one or both arms shall attempt to save even a drowning monarch, or to blame a misdirected stranger for taking the wrong course.
     It must be granted that an epileptic is a lunatic pro tem. His mental balance may be lost for but a moment or for minutes or for hours or days or weeks or months. If his conduct during this spell has been ridiculous or even grossly violent and without any purpose that seems intelligible to others, he will quite likely be admitted to be insane by even a stupid jury. But if, as quite often happens, he display an impulse which corresponds to some known provocation and which he may have held in check for a longer or shorter period, the apology of insanity is not so readily granted, for too frequently it is supposed by laymen that lunatics are entirely devoid of ordinary motives, just as if the loss of some ideas necessitated the loss of all or precluded the operation of previously acquired knowledge and sentiment. And yet the rush of a latent or restrained impulse is to be most expected when the normal or standard inhibitory powers are thrown aside without a conscious act. Under such conditions a pent up emotion will naturally assume freedom of execution just as the conceptions of a musical amateur have been displayed with transcendent excellence only in the course of a somnambulistic trance. In both cases the emotions or desires are untrammeled by certain restraints of previous teaching and experience and which operate under ordinary conditions. As before observed, in epilepsy only certain inhibitory or regulating powers may be lost, while in all other respects the subject may be keenly perceptive in a more or less automatic way.
     The remark occasionally met with that all epileptics do not commit crime and which is intended to suggest that the crime is something apart from the epilepsy and should be so treated, is quite on a par with the observation that all whisky drinkers do not have red noses. To skeptics we can also quote the [13][14] maxim that it was the last straw that broke the camel’s back and without it the camel’s back would not have been broken. There are psychological as well as physiological variants in the personal equation which are just as inexplicable as is epilepsy and it cannot be expected that the same cause differently associated will produce all of the same results. And is it not true that there are moments in the lives of nearly all men and women when if but a single thought were obscured, a so-called “righteous indignation” would quite naturally culminate in a crime. But as previously indicated the background causative factors chiefly belong to heredity and environment and which on the moral side are mainly the products of social and political conditions.
     Between spells epileptics must be regarded as combustible material to an unknown spark, and in the event of crime they are entitled to the presumption of temporary insanity. There certainly cannot be a more worthy occasion for the “benefit of the doubt,” at least until the case is properly studied. In my opinion the attitude of the medical expert should accord with the true spirit and purpose of the law, i. e., justice and economy. The ordinary idea of punishment which is usually the object of a state trial should be entirely expunged by a rational theory of remedial treatment, for even the desire to inflict punishment in the ordinary legal way is itself a sign of an abnormal disposition, the product of an exaggerated ego and defective intelligence. This is true absolutely and without exception, so that the attitude of society which will best serve and the one most likely to secure justice to offenders is the attitude of true charity, i. e., study, explanation and the application of remedial treatment in accordance with the intelligence of the times and the spirit of the universal monitor, THE GOLDEN RULE.


     It is doubtless a long way between a yawn and a fit, and yet there presumably exists a degree of kinship inasmuch as both phenomena are spasmodic and involuntary. According to Sir William Gowers, the most frequently observed prodroma of epilepsy are sudden jerks of the body or limbs, and it seems to me quite probable that the assassin Czolgosz was not far from being an epileptic, for it was reported of him that he had marked twitchings of the right forearm while in the court room and of the lower jaw just before his electrocution. He probably had similar manifestations at other times. Fear or emotional agitation could only be regarded as exciting causes at the most, for involuntary spasms always indicate an important physiological fact, whether or not they can be regarded as prodromal or epilepsy. It is true such phenomena are frequently observed in persons quite properly regarded as sane, although they may possess but a shell of sanity liable to break down by just a little more pressure. A thoroughly sound person does not have such manifestations under any circumstances of purely mental influence.
     But in analysing the Czolgosz case I will discuss his mental condition from three view points, namely:
     (1) The act. (2) His behavior subsequent to the act. (3) His history previous to the act.
     The present sketch is necessarily very brief, yet I think it presents the essential nature of the case quite distinctly and fairly.
     In reference to the act I may first observe that acts themselves indicate the mental condition of the actors, when all the circumstances are known, and that in reality they constitute the best of evidence, just as the work of the mechanic exhibits his skill, or the lack of it, when the purpose and conditions of his labors are known.
     The evidence of sanity essentially depends upon the integrity of reason, [14][15] the chief tests for which are constancy, coherence, and a rational necessity or expediency for all acts.
     In regard to the indications of the act of Czolgosz, I deem the following points worthy of serious consideration, and as indicating insanity, viz.:
     (1) At the age of 28 and after a life record of an exceptionally (abnormally) retiring and peaceful disposition, he suddenly appears as a great criminal. Had he been sane, this would imply an infraction of the law of normal growth.
     (2) His act was not only homicidal but it was also deliberately suicidal, for he expected to be hanged for it; yet it was not based upon any philosophy, teaching or experience within his knowledge or imagination which offered him any hope of reward of any kind, either in time or eternity.
     (3) His act was wanton, for he had in mind no benefit that would or could accrue to any person or class of persons; while, on the other hand, had he been simply an anarchist, he would have known that distress or disfavor would fall upon all of his class. But his act appears as motiveless as is the case in pure kleptomania.
     (4) Such a monstrous conception and impulse as the wanton murder of the President of the United States, arising in the mind of so insignificant a citizen, without his being either insane or degenerate, could be nothing short of a miracle, for the reason that we require like causes to explain like results. To assume that he was sane is to assume that he did a sane act, i. e., one based upon facts and for a rational purpose.
     (5) If he thought President McKinley was “the enemy of the good people, the poor working people,” as he asserted, the notion must be conceded to be the pure product of a deluded imagination, for there was no evidence of any kind or anywhere in support of it. And there is no evidence that Czolgosz was a prophet, statesman or philosopher of transcendent insight.
     (6) His act was not the natural product of any form of systematic thought. He was not an anarchist nor a student of anarchy, nor a student of anything else; while the fundamental principle of anarchy is a denial of the right of any one to interfere with the liberty of any one else, and thus it is opposed to the committing of violence in any form.
     (7) The “I done my duty” notion was evidently an imperative idea of a purely impulsive origin, for he did not believe he had been specially called to do the deed. Such a condition is common among lunatics, especially in the earlier stages of their affliction. It is also to be observed that the impulse arose suddenly from a suggestion through something he read three or four days before his murderous assault.
     (8) His act was not an act of revenge of any kind, for the President had wronged neither him nor a relative of his, nor a friend of his, nor any class of people in which he had the slightest interest.
     Now, granting that these points are true, let us ask where was the rational motive, purpose or basis in this act? How much was it like a rational philanthropic act or a criminal act of the selfish order?
     If we inspect the remarkably brief and superficial report made by the State’s medical examiners, (5) we will find in it a few straws which indicate something of the condition of his mental undercurrents shortly before and shortly after the assault. To-wit:
     (1) Mental wandering and abandon, e. g., a few days before the act he went from Buffalo to Cleveland, a distance of nearly 200 miles, “just to look around and buy a paper,” as he declared.
     (2) Insane vacillation, e. g., on one occasion he denied that he killed the President or had any intention of doing so, but a few minutes later he remarked, “I am glad I did it.”
     (3) Logical incongruity, e. g., he declared that any one had a chance on [15][16] trial and that perhaps he would not be punished so badly after all. Yet from first to last, he treated the only persons, his lawyers, who could secure the chance for him, with the most contemptible indifference.
     (4) Moral chaos, e. g., he declared he did not believe in government nor in law, nor in marriage, nor in God.
     (5) Insane egotism, e. g., his reason for killing the President was “I done my duty. I don’t believe in one man having so much service and another man should have none.”
     Now, let us ask ourselves if any of these conditions indicate a sane and responsible state of mind.
     In regard to his previous history, my investigations, personally made at his home in Cleveland, disclose the following facts, namely:
     (1) As a child he was markedly indisposed to associate with other children.
     (2) As a young man he studiously avoided the opposite sex and did not have a chum of any kind.
     (3) He was seldom distinctly ill, yet he was almost always complaining of ill health and frequently took medicine.
     (4) He was notoriously prone to fall asleep in a chair at any hour of the day, and as indicating a common peculiarity, his bright old aunt termed him an “old grand-mother,” because he had such “a tired, stupid way.”
     (5) He took special interest in nothing, never spoke at club meetings and was with difficulty induced to read any kind of literature, even that of the Social-Labor party, the local club of which he was for some time a member.
     (6) At the age of 24 years he quit work at the wire mill on account of his health, as he claimed to his relatives, and went to live on his father’s farm, where he remained until about two months before the assassination. Here he lived in comparative idleness, claiming that on account of his health he could not do farm work, and actually did nothing but petty odd jobs just when he “felt like it.” He had no books and did no reading excepting as he casually picked up a local German newspaper which came to the family.
     (I wish here to acknowledge my indebtedness to Mr. L. J. Czechowski, the druggist of the neighborhood of the Czolgosz family, for his most valuable assistance in my Cleveland investigation.)
     We thus see that his previous history reveals the development of a distinctly abnormal condition in his character and which could hardly be expected to continue much longer without a break or some peculiar overt manifestation, the precise form of which would more or less depend upon the suggestions made to such a peculiar mind by passing events.
     And yet he has been declared an “anarchist, sane and responsible” by the State’s medical advisors. If, however, we examine the introductory remarks of their official report, we find them congratulating themselves that they had an early chance to examine Czolgosz “before he had time to meditate upon the enormity of his act,” which is simply a frank admission that they believed he did not realize at that time the enormity of his act, and therefore that he must have been insane. It is also an admission that they expected a reaction would follow in the assassin’s mind, i. e., that he would recover his senses and become sane and then begin in some manner to play off, so to speak. But it seems that after all the “done my duty” idea of Czolgosz held him up from start to finish, quite as insane egos commonly do.
     The declaration by the medical examiners that he was neither insane nor degenerate (degeneracy is supposed to be a sort of insanity dependent upon or co-existent with inherited organic defects) quite ignores the theory of evolution, while it does not even indicate how such a monstrous act could be perpetrated by a “sane and responsible” person. The sanity of an American citi- [16][17] zen must indeed be a strange and uncertain quantity according to any standard that admits of such a declaration.
     Czolgosz was not a type frequently found in our public lunatic asylums, but rather an aggravated specimen from the insane borderlands. Four years of voluntary idleness on a farm remote from city privileges, and at a time of life when normal young men are most alive and ambitious, could hardly do less than increase the very morbidity which must account for such a choice. And while it would increase his abnormal feelings and suggestibility, insane conceptions were but naturally bred under such conditions. His main delusion, his “duty” as he called it, was fixed to the last, which is reasonable evidence that it had an established setting which required but little suggestion of an abnormal kind to break through his remaining circumspection. Delusions which are based upon some system of reasoning are not so fixed against opposing reasoning or evidence as are delusions which more or less suddenly enter or arise in the mind by virtue of some form of mental disorder which so entangles them that no amount of reasoning can dislodge them. Czolgosz can no more be regarded an anarchist or a rational product of anarchy than a casual visitor to a synagogue can be regarded as an orthodox Jew. Neither the Cleveland superintendent of police nor myself could find any trace of any interest or of any association whatever on the part of Czolgosz with either anarchy or anarchists. Yet I do not deny that his disordered mind was moved by notions which he attributed to anarchy, as it is commonly understood. But I have seen cases which an orthodox sermon or a series of camp-meetings have led to the lunatic asylum. Yet the normal effect of Christianity is not that way.


     Since writing the preceding paper, I met with a recent article by Dr. Regis of France, on Regicides, from which the following extracts are taken (6): Refering [sic] to the mental condition of regicides Dr. Regis says: “Some idea, good or bad, following on such prepared soil, soon germinates in an exaggerated manner; whatever sane reason such a subject may have possessed up to that date, gives way to a sickly choking ideation which ends in the subject’s delusional conviction that he is called on to deal a great blow, to sacrifice his life for a just cause, to kill a monarch or a dignitary in the name of God, the fatherland, liberty, anarchy or some other analagous [sic] principle.”
     “It is impossible, it seems to me, to consider these individuals as ordinary criminals and not to see in them fanaticized, sick men, almost at the point of suffering from delirium. They are so identical one to the other that the resemblance may be traced trait for trait.
     “On the ground of the ensemble of their natures, I define them as follows: Degenerates of a mystic temperament, who, misguided by political and religious delirium, complicated sometimes by hallucinations, think themselves called on to act the double role of judiciary and martyr; who, under the influence of an obsession that is irrisistible [sic], kill some great personagle [sic] in the name of God, the country, Liberty or Anarchy.
     “Besides, regicides who survive almost invariably end in insanity and complete dementia. This confirms my opinion that they are unbalanced. As examples may be cited Sahla, Galeote, Passanante, Berardi and Acciarito.
     “And yet, although sick, although delusional, although impulsive, they are almost always treated as responsible individuals, condemned to death both in order to punish them and make examples of them. For my part I think this method is both erroneous and unprofitable and that society would be the gainer by treating these dangerous subjects, who so often cause upheavals of government, as insane patients.”
     Marshall Field Building, Chicago.



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