Hektoen International

A Journal of Medical Humanities

Earliest instance of Alzheimer’s disease as defense in a 1924 homicide trial

Saty Satya-Murti
Joseph Lockhart
Santa Maria, California, United States

Top left: Rev. Hight behind bars. Top right: Elsie Sweetin. True Detective Mysteries Vol. XIII, No. 1, 63. April 1930, New Metropolitan Fiction, Inc., Dunellen, NJ. Via Internet Archive.
Bottom: Left to right: Elsie Sweetin, attorney Robert Smith, Rev. Hight, and his attorney Nelson Layman. Philadelphia Inquirer, Dec 14, 1924. Via Internet Archive.

In the mid-twentieth century, few doctors and even fewer members of the public had ever heard of Alzheimer’s disease (AD). Interest focused on senile dementia and arteriosclerotic vascular dementia while presenile dementia was thought to be uncommon and received little attention.1 Yet as early as 1906, Alois Alzheimer (1864–1915) had reported clinical and neuropathological findings from one of his patients, “Auguste D,” who died at age fifty-six after having progressing dementia symptoms for five years. Within the next few years, other neurologists reported similar cases. Emil Kraepelin (1848–1915), a colleague and mentor for Alzheimer, called this dementing illness Alzheimer’s Disease. These descriptions, however, failed to garner much recognition until the late 1970s.2

An unexpected exception to this awareness gap occurred in 1924 when the Hight-Sweetin double homicide trial in Ina, Illinois, captivated international attention.3 It involved the Rev. Lawrence Hight, a married forty-year-old ex-jockey and circuit preacher in Cairo in southern Illinois. He was accused of the arsenic poisoning deaths of his lover’s husband and of his own wife. His congregant and alleged lover was thirty-one-year-old Elsie Sweetin, married to forty-one-year-old Wilford Sweetin.

In July 1924, Wilford Sweetin suffered a minor injury at work and became sick to his stomach. His symptoms were attributed to ptomaine poisoning. Several doctors and Hight came to see him, but his condition deteriorated, and he died on July 28. Rev. Hight preached at his funeral. Less than two months later, Hight’s wife Anna became ill after eating minced ham. She became paralyzed and vomited blood, received a diagnosis of food poisoning, and died on September 12.

At the coroner’s inquest the owner of the only local store denied that Hight had bought minced ham there. Hight declined to answer further questions without an attorney present. The inquest was postponed while Anna’s exhumed body revealed arsenic in the viscera. At this point, Frank G. Thompson, the local prosecutor, became involved in the case. Hight was arraigned and jailed for the murder of his wife.

With the exception of the Hight-Sweetin trial in 1924, there was a long gap in early to mid-20th century about awareness of Alzheimer’s Disease. 

A forensic scientist from Chicago confirmed the presence of arsenic in Wilford’s body as well. Hight then signed a confession that fell short of premeditated murder, admitting to a love affair with Elsie and to have provided her with the arsenic to kill her husband. Under duress and with Hight’s urging, Ms. Sweetin also signed a confession admitting to poisoning him. On October 13, 1924, the pair was indicted for the murders by a grand jury. The trial, with Nelson Layman as the court-appointed attorney for Hight, began on December 9, 1924. Layman’s defense was that Hight suffered from insanity due to AD, and thus was not guilty.

Hight’s case drew incredible attention in the United States and Canada. Alzheimer’s disease was a novel diagnosis. Layman used this defense in the hope that his client would escape the death penalty. Evidence was presented throughout late December, and the case finally went to the jury on December 23rd. “Not Guilty by Reason of Insanity” was one potential verdict. After deliberating all night, the jury returned a verdict on the morning of Christmas Eve. In spite of an energetic AD defense, both Hight and Sweetin were found guilty, with Hight receiving a life sentence and Sweetin 35 years in prison. However, they were spared the death penalty.

At a time when very few physicians had even heard of AD, how did the legal profession, specifically Layman, come to learn about it?

By the late 1800s and early 1900s, invoking insanity as a legal defense had become an accepted strategy. In 1888, Sarah Whiteling poisoned her husband and two children with arsenic. Her defense on grounds of menstrual insanity failed, and she was hanged in 1889 in Philadelphia. But when in 1907 millionaire Harry Thaw (1871–1947) shot and killed architect Stanford White, Thaw’s legal team successfully claimed temporary insanity due to a “brain-storm.” The jury did not return a murder verdict.5

On Dec 26, 1924, St. Louis Globe-Democrat Predicted the “collapse” of the future importance of Alzheimer’s Disease’s relevance to criminal jurisprudence. Via Newspapers.com.

It is unclear how Layman, a defense attorney and not a physician, might have gained awareness of the term “Alzheimer’s disease,” but he would have been familiar with the precedent insanity defense cases. It is less likely that he had read the seminal 1907 German version of Alzheimer’s paper or the works of Krafft-Ebing, a German psychiatrist and an early scholar in the field of deviant sexual behavior. However, Layman was probably aware of Frank Parsons Norbury, a prominent Illinois physician and a superintendent of the state hospital in Kankakee, IL. Norbury was a published author on the subject of classifying and caring for the insane, including a classic 1893 treatise on “The Insanity of Age.”6 Thus, it is more likely Layman had read the works of Norbury, a local luminary, whom he frequently quoted when interviewed by reporters.

This was a time when a plethora of ill-defined constructs and terms were used to explain homicidal behavior.7 Opposing counsels threw nebulous terms at each other. By contrast, Layman had offered apparent diagnostic specificity and certitude. A new diagnosis with an august German lineage, narratives from a respected regional authority like Norbury, and a sprinkling of technical vocabulary were the arguments intended to raise doubts regarding Hight’s sanity.8 However, the prosecution presented clear evidence of Hight’s retained memory, meticulous planning, and sequential execution, supported by witness testimony and documentation of arsenic purchase by Hight. This evidence convinced the jury and the court that the murderous acts were premeditated.


In 1927, Mrs. Sweetin appealed her conviction to the Illinois Supreme Court on grounds that her confessions had been coerced, and that the conjoint trial with Hight unduly prejudiced the jury. Her conviction was reversed, and she was acquitted and released.9 Hight was released after serving twenty-seven years and died at the age of eighty-four. Sweetin married twice again after her acquittal. She died in 1960 in San Diego, California. Layman switched sides to become a prosecutor, and later died in 1936 at age fifty-five.

Interest in AD waned after a brief flash of publicity, and did not return until the 1970s. The St. Louis Globe Democrat predicted that most juries would be unlikely to be impressed by “mouth-filling” terms of “consonants.”10 This pronouncement was prophetic in view of its applicability to even current times. Later attempts at using AD as legal defenses have rarely been successful. Whether in 1924 or today, the evidence has been unconvincing that it is possible to connect overt criminal conduct with a specific brain disease and thus eliminate criminal culpability. It has, however, mitigated a death penalty to a life sentence.11

End notes

For full references and commentary, please contact the authors.

  1. Peter Rabins, “Science and Medicine in the Spotlight: Alzheimer’s Disease as an Example,” Perspectives in Biology and Medicine 1988;31(2):161-70; James Fletcher, The Biopolitics of Dementia: A Neurocritical Perspective 1st ed (London: Routledge, 2023); “Milestones,” Alzheimer’s Association, 2024. https://www.alz.org/alzheimers-dementia/research_progress/milestones
  2. Due credit for recognition of AD does belong to Alzheimer. Other notable but hardly recognized descriptions of this illness came from Oskar Fischer in 1907, Simon Carter Fuller in 1907, Francesco Bonfiglio (1883–1966), and Gaetano Perusini within a span of 5–10 years. Perhaps Kraeplin’s fame elevated Alzheimer’s name well above that of other equally valid contributors.
  3. Dozens of US, Canadian, and Australian newspapers reported on this case, including The New York Times and The Los Angeles Times. Nearly all period newspapers printed unauthored reports or syndicated feeds.
  4. The best publicity that Layman received was from a Los Angeles Times header that claimed, “Very Few Physicians” knew about AD but “even a layman would easily recognize it.” Los Angeles Times, “Novel Insanity Plea for Hight: Attorneys Aver Preacher Has Alzheimer’s Disease Very Few Physicians Know of Such Malady,” December 14, 1924.
  5. Kenneth Weiss, “Arsenic, Familicide, and Female Physiology in Nineteenth-Century America,” Journal of the American Academy of Psychiatry and the Law Online 2020;48(3):384-92; Emil Pinta, “Examining Harry Thaw’s ‘Brain-Storm’ Defense: APA and ANA Presidents as Expert Witnesses in a 1907 Trial,” Psychiatr Q 2008;79:83-9.
  6. Norbury’s essay had suggested that the severe psychological deficits in old age might represent a “senile dementia,” syphilitic disease, or “a chronic cerebral atrophy” in which the “nerve cells” undergo “primarily a parenchymatous degeneration.” We could speculate that the last entity might actually have been a description of Alzheimer’s disease. Frank Norbury, “‘Some Remarks on Insanity of the Aged,’ Read in the Section of Neurology and Medical Jurisprudence, at the Forty-Fourth Annual Meeting of the American Medical Association.” JAMA 1893;21(15):519.
  7. From the days of Kraepelin, and even today, the use of imprecise terms in the cognitive fields is not uncommon. EJ Engstrom and MM Weber, “The Directions of Psychiatric Research by Emil Kraepelin,” History of Psychiatry, Sept 2005;(63):345-9; Pinta, “‘Brain-Storm’ Defense”; Saty Satya-Murti and Joseph Lockhart, “Needed: Consensus and Classification for Terms Used in Cognitive, Forensic and Clinical Bias Discussions,” Forensic Science International Dec 2018;293:e10-1.
  8. Although Layman had often borrowed verbiage from Norbury, he did not bring him to participate in the trial in any capacity. Our research leads us to believe that Norbury probably did not consider Hight as being demented.
  9. Illinois v. Sweetin, 156 N.E. 354 (Ill. 1927).
  10. “The Collapse of Alzheimerism,” St. Louis Globe-Democrat, December 26, 1924.
  11. Neither new technology nor novel terminology has been shown to succeed consistently in exculpation of the accused. JR Ciccone, “Murder, Insanity, and Medical Expert Witnesses,” Archives of Neurology 1992;49(6):608-11; Michael Vitacco et al, “The Limited Relevance of Neuroimaging in Insanity Evaluations,” Neuroethics 2020;13(3):249-60; Ryan Darby, “Neuroimaging Abnormalities in Neurological Patients with Criminal Behavior,” Current Neurology and Neuroscience Reports 2017;18(8):47.8; US v. Thomas Vincent Girardi, US District Court, Central District of California, Case No. 2:23-CR00047-JLS, 1/5/24, “Order finding defendant competent to stand trial.”

SATY SATYA-MURTI, MD, FAAN, is a clinical neurologist and health policy consultant. Following retirement, Saty has spent time researching cognitive biases, the social underpinnings of clinical medicine, Progressive Era medicine, and forensic sciences. He enjoys grandparenting, solar cooking, and volunteering. 

JOSEPH (JERRY) LOCKHART, PhD, ABPP, is board certified in forensic psychology, and is a Fellow of the American Academy of Forensic Psychology. Jerry has extensive experience in clinical, forensic, and correctional psychology. He has published and presented on the reliability of forensic assessments, including bias reduction in clinical and forensic decision-making. He enjoys reading the history of science and improving his Spanish for clinical and personal use. 

Spring 2024



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