Mad Doctors in the Dock: Defending the Diagnosis, 1760–1913 by Joel Peter Eigen (review)

Readers familiar with Joel Eigen’s work will welcome this last in a series of three monographs that examine the insanity defenses given in trials held at London’s central criminal court, the Old Bailey, from 1760 to 1913. Bringing the total number of trials studied to 994, this book focuses on the years 1876 to 1913 when the participation rate of medical witnesses was at its highest and homicidal mania emerged as a disease on which medical diagnosis, legal fact finding, and popular understandings of mental illness reached an unexpected accommodation. Forensic psychiatry was firmly established as a profession and its practitioners as expert witnesses.

The book comprises an introduction, seven chapters, and a substantial conclusion. The analytical framework is introduced, medical witnesses carefully situated in relation to the main legal actors (lawyers, judges, and juries), and the methodology explained. Rather than verdicts, which offer an “unreliable and often misleading metric of courtroom history” (p. 8), Eigen has read through all the trial narratives looking for the authentic voices of doctors, prisoners, and legal personnel. Chapter 1 provides an overview of insanity trials, with useful statistical data on acquittal rates, concluding that medical witnesses do not appear to have adopted partisan views. Chapter 2 surveys the key medical terms involved in the trials: melancholia, mania, and delusion, all of which were so adaptable that they could be used to account for apparently motiveless crimes.

Chapter 3 shifts the focus to medical practitioners, to show that prison and police surgeons took on an increasingly important role due to their direct experience with defendants. Chapters 4 and 5 examine courtroom diagnoses, the former showing that “delusion” became the term that separated medical from lay interpretations of the same observations of mental instability, the latter that in cross-examination lawyers tried to compel medical witnesses to state how the diagnosis affected a perpetrator’s ability to know the nature and quality of the act he or she had committed. The next chapter examines homicidal mania, a diagnosis reached in thirty trials (the first in 1857) by forty-three doctors, half of whom cited delusions as evidence. Chapter 7 reveals the active role of judges in insanity trials: their goal was to determine the significance of medical evidence to legal fact finding and keep jurors focused on establishing what a prisoner knew he or she was doing and would likely have believed about the outcome of the act (p. 156). The conclusion analyzes the findings in relation to a sociological theory of how professions develop, identifying folk knowledge, professional experience, and structural innovations in criminal justice administration as key conditions “for the entrance of a new expert witness armed with a new diagnosis” (p. 179).

The book is very well written and attractively presented, but there is no bibliography; a heavier use of secondary referencing would relate the analysis more closely to the relevant legal historiography, and persnickety readers will spot the odd minor error—Broadmoor Criminal Lunatic Asylum opened in 1863, not 1864 (p. 25), for example. More importantly, the minimalist system used to cite the Old Bailey trials makes it very difficult to trace individual cases, as neither the defendant’s name nor the trial date is provided. It would have been much more helpful had the author used the trial reference numbers created by the now indispensable Proceedings of the Old Bailey, 1674–1913 online resource (www.oldbaileyonline.org). This usage would have revealed that Henry Maudsley was house surgeon at University College Hospital in May 1855 (see ref. no. t18550611-615), not “University Lodge Hospital” (p. 128).

These concerns aside, there is no doubt that this is an important book that entirely accomplishes its stated goals, providing a satisfying answer to its central research question and suggesting major areas for further research. These include the role of police surgeons in the history of medicolegal practice; the ways...