Billeder på siden
PDF
ePub

Association, of the Chicago Medical Society, and had been a member of several of the Congresses of American Physicians and Surgeons. He served as surgeon on the active and consulting staffs of a number of charitable institutions, notably the Cook County Hospital, Saint Joseph's Hospital, Saint Luke's Hospital, and especially the Presbyterian Hospital, intimately connected as this was with the Rush Medical College, where he held the Chair of Surgery for nearly twenty full years.

On the fourth of November, 1887, after an illness of some weeks, this noble physician passed beyond the veil to his well-earned reward. He was a lifelong, consistent and faithful member of the Episcopal church, belonging to the old-fashioned high church school. Despite the materialism of many of his fellow-doctors, he said, "I often doubt terribly, but I say to myself, I looked this thing all over once, I went through the arguments and I decided that the immense balance of testimony was in favor of Christianity, and I cannot take time to go all over it again."

Doctor Gunn's tenderness to his child patients and their love in return for him was very striking. His fondness for animals, flowers and natural beauty was strongly developed and freely indulged. Unlike too many physicians, he did not permit his profession to absorb and narrow him, if for no other reason, lest his powers as a practitioner and teacher should be crippled thereby. In addition to the study of foreign languages and the literature of our own tongue, Doctor Gunn was at one time a most enthusiastic and well-informed astronomer, thus providing himself with a resource which, when drawn upon, could bear him away from his daily worries, rest his mind, and serve to elevate his thoughts from material to spiritual things. Well would it be if every one of us would strive for some form of knowledge and culture alien to that of our profession. Doctor Gunn was fond of and shone in society as a conversationalist, now one of the nearly lost

arts.

I have apparently striven thus far to present you an idealized picture of a flawless man, which none of us believes to exist. It remains for me in my peroration to point out some of the glaring defects inseparable from a character such as I have endeavored to depict. He was imbued rather too strongly with a sense of self-respect, allied to, but something far nobler, than conceit. Conceiving the idea. that he was born to govern in many things he sometimes aspired to command outside of his legitimate sphere. He was intolerant of argument on almost any subject, and often did scant justice to his opponents. He could be bitingly sarcastic, and resort to ridicule, which, as I once told him, was not argument, and totally out of place in a scientific discussion. He was prompt and sharp in his dealings with the blunders and shortcomings of anyone who failed to do what he considered was their best. In some things he was radical to the point of being revolutionary. He never catered for popularity by shading his expressions of opinion, but struck as hard as it suited him, without regard for consequences. In his determination to be absolutely honest in the

expression of his opinions he sometimes appeared harsh, when he was really actuated by the best motives. While tenacious of professional opinion, he never claimed to be able invariably to correctly diagnose the innumerable conditions presented for his consideration, often quoting to the students, the saying, "if your foresight was as good as your hindsight you would not make so many mistakes by a sight." He was an ideal consultant, never by word or action criticizing. the attendant before the patient; if he had anything uncomplimentary to say, it was said to the physician, as it always should be, in private.

To sum up, then, Gunn was a notable and noble figure of a man, one of whom the profession and especially this school has good reason to be proud. An honest, high-toned, unselfish, Christian gentleman; a hater of shams in any form; a good son, husband and father; an example of devotion to the noblest of professions, and through it a benefactor of humanity; our most illustrious Founder, one whom every student present should strive to emulate.

And now, shade of a most gallant and knightly physician, whose shield was so often successfully interposed between his intended victims and the Grim Destroyer-Death, farewell. May the example of your life shine as a beacon light to lead us on to nobler endeavor, and may the voice of your teachings long continue to "echo through the corridors of Time."

I append the following list of his writings:

"Philosophy of Certain Dislocations of the Hip and Shoulder, and their Reduction." Peninsular Journal of Medicine, Ann Arbor, 1853-4, Volume I, pages 95-100.

Reprinted with some additions in the same journal 1855-6, Volume III, pages 27-35.

Reprinted in pamphlet form, 1855.

Reprinted with further additions in the Peninsular and Independent
Medical Journal, 1859-60, Volume II, pages 193-206.

Reprinted in pamphlet form 1859.

Second edition printed in 1869.

"Selections from Surgical Notes." Medical Independent, Detroit, 1857-8, Volume III, pages 67, 186, 257, 377, 469, 575.

"Selections from Surgical Notes." Peninsular and Independent Medical Journal, Detroit, 1858-9, Volume I, pages 464-467; 1859-60, Volume II, pages 140-143.

Doctor Gunn was one of the editors of the Monthly Independent, Detroit, 1857-8, Volume III, and of the Peninsular and Independent Medical Journal, 1858-9, Volume I; and 1859-60, Volume II; and was the author of numerous editorials in these journals, usually signed "G.”

"Address of Welcome to Rush Medical College," delivered October 1, 1867, Chicago Medical Journal, 1867, Volume XXIV, pages 499-512.

"Valedictory Address, Rush Medical College," 1870-71. Ibid., 1871, Volume XXVIII, pages 157-169; also reprinted.

"Surgical Clinic of Rush Medical College." Ibid., 1874, Volume XXI, pages 560, 725.

"Discussion of Doctor Gross' Paper on Syphilis." "Transactions American Medical Association," Philadelphia, 1874. Volume XXV, page 243.

"Case of Traumatic Tetanus, Saint Joseph's Hospital." Chicago Medical Journal and Examiner, 1875, Volume XXXII, pages 421-426.

"Address in Surgery and Anatomy," delivered May 8, 1879. "Transactions American Medical Association," Philadelphia, 1879, Volume XXX, pages 79-493.

"Report of a Case of Purulent Effusion into Knee-Joint." Ibid., 1879, Volume XXX, page 517.

"Treatment of Fractures of the Skull, Recent and Chronic, with Depression." Read June 1, 1882. "Transactions of the American Surgical Association," 1881-83. Philadelphia, 1883, Volume I, pages 83-90.

"The Doctorate Address on Medical Ethics." Chicago Medical Journal and Examiner, 1883, Volume XLVI, pages 337-352. Also reprinted.

"The Philosophy of Manipulation in the Reduction of the Hip and Shoulder Dislocations." "Transactions American Surgical Association," (1884) 1885, Volume II, pages 399-519; also in Chicago Medical Journal and Examiner, 1874, Volume XLVIII, pages 449-468. Also reprinted.

"The Union of Nerves of Different Function Considered in its Pathological and Surgical Relations." Address of the President delivered April 28, 1886, Volume IV, pages 1-13.

BORDERLAND CASES OF INSANITY.*

BY IRWIN H. NEFF, M. D., PONTIAC, MICHIGAN.

ASSISTANT PHYSICIAN AT THE EASTERN MICHIGAN ASYLUM FOR THE INSANE.

THE subject which I have chosen is not an uninteresting one. Many cases of questionable insanity have been reported and valuable information has been obtained. A reference to the literature on this subject will show a voluminous bibliography. My intention is not to particularize, but to correlate some of our knowledge on this subject. and isolate a few of its practical applications,-facts which would appeal to the interest of the general practitioner.

Borderland cases, correctly speaking, would comprise all those cases in which the alleged irresponsibility of the individual is unproven. As is well known such a definition would include a number of conditions, and it is true that many and diverse symptoms accompany such a case. It is obvious that one considering a "borderland case" must be conversant with both normal and abnormal psychology. As it is admitted that the origin of the moral sense has no fixed period, we see that a priori we have a task of no little importance.

I would also call attention to the fact that we are in danger of going to the extreme. On one hand we have the ruling of the criminologists and students of sociology; and again we are confronted with the statement of the extremist, who declares that since the degree of responsibility cannot always be defined, everyone should have an equal chance, and that consequently we should show leniency when occasion demands. Many attempts have been made to prove or disapprove these statements, but it must be acknowledged that we have reached no conclusion which can give satisfaction.

Read at the Ann Arbor meeting of the FIRST COUNCILOR DISTRICT MEDICAL SOCIETY, December 22, 1905.

For a settlement of this perplexing question we naturally turn to the alienists and criminologists. Let us see what they have to contribute.

Our conception of insanity today is vastly different from our idea. of the psychosis twenty-five years ago, and this is, in great part, owing to our improved clinical interpretation of mental disorders. Much of the mystery surrounding practical psychiatry has vanished, we hope forever. A careful study of a number of cases has shown that a grouping of cases is possible, thereby making the nomenclature of insanity possible, and simplifying, it to a remarkable degree. We have also more correct and definite explanatory terms, and have brought closer together the relationship of the neurosis to the psychosis. And, lastly, I would call attention to the relationship of bodily conditions and mental disturbances. Although we believe that in insanity the essential condition is a disordered action of the brain, we admit that the causes producing such a disruption may be dependent upon bodily disease or defect. It is not strange, considering these revelations, that the psychiatrists should demand a more careful study of these cases. They believe that a more painstaking inquiry into each individual case, along certain definite lines, would be of material assistance in clearing up the vexed question of "responsibility."

A review of the writings of alienists on the vexed question of "responsibility" will show that there is quite a uniform opinion on the question of its restriction. According to a number of prominent alienists diminished responsibility is to be charged in cases of even slight mental affections, in incipient stages of others (as in that of general paralysis), in some psychic degenerations, without delirium, in borderland cases of insanity, cases of sexual perversion, chronic alcoholism, neurasthenia, the general epilepsies, and in certain cases of the other neuroses.

Mercier claims that there is a certain sphere of activity, in which every insane individual is to be held irresponsible, but outside of which, any act of his may be punishable by law, so that but a few insane can be held entirely irresponsible. Mercier inclines to the idea that the physician should not be permitted, as such, to decide on the degree of responsibility in these cases, but should simply and clearly describe the patient's mental state, leaving to the judge the application of the law (Journal of Nervous and Mental Disease, Volume XXIX, page 739).

The criminologist, proceeding in much the same way as the alienist, has discovered truths which have proven to be of practical importance. As is well known the relation of crime to insanity has been the nucleus on which has been built our present knowledge of the criminal. It has been definitely decided that there is a true relation, a relation, which like insanity in some of its respects, is difficult to analyze.

In order to emphasize these statements, and wishing to show concerted opinion in regard to the responsibility of the criminal, I give the following quotation: Doctor W. B. Noyes, writing on the "Crim

inal Equivalent of Insanity," says that "the importance of fixed idea or obsession on obscure cases in crime cannot be too frequently brought to the attention of jurists, and the presence of minor eccentricities is also important, for there is no sharp line to be drawn between the eccentric and criminal action." Such mental eccentricities, Noyes believes, are often as clearly stigmata of degeneration as the more definitely understood physical stigmata. He also speaks of the criminal, who knows both concrete and abstract, but lacks what he calls "hidden or ethical feeling." "Such a man knows right and wrong, but will not, on that account, be kept from committing wrong."

The practical application of these facts is possible, but united and uniform action is called for. It is obvious that there can be no fixed rule in "borderland cases," but it is nevertheless true that our judgment is called for, and our opinion must be rendered. It is true that our medical opinions, which should be respected, are often overruled; but we should never hesitate to give our verdict, even to the extent of frankly acknowledging our inability to render more than a conservative opinion.

The necessity for expert testimony in these borderland cases is apparent. It is unquestionable that medical expert testimony would be less severely condemned if only the physician familiar with mental trouble would consent to testify. An alleged case of insanity cannot be hastily decided upon, for the diagnosis should not be placed on the existence of a delusion or the presence of some peculiarity, alone. The diagnosis of mental disease should rather be dependent on the sum of bodily and mental defects, and the proper correlation of facts gained by a thorough study of the patient.

Naturally the determination of insanity in a "borderland case" requires the most exquisite care. The case must be most carefully considered and extended examinations are often demanded. When summoned to examine such a case the physician must remember the character of insanity and appreciate the difficulties which he will encounter. The psychiatrist knows that the case requires a most careful handling, and that he, in all probability, will be met with opposition, which, if he is not experienced, may affect his final decision. One should also bear in mind that although the practical grouping of the insanities is now possible, cases are found which cannot be relegated to any one particular group. Nevertheless such cases are cases of insanity. The physician should not hesitate to so declare it, giving his specific reasons and acknowledging his inability to classify it. It must also not be forgotten that insanity is a protean disease, and it may be that the peculiarity exhibited by the patient is a prodromal or primary. symptom of a well recognized form of insanity. We should never arrive hastily at our conclusion, and one must remember that when undertaking such a case he has set for himself a task which will require both tact and perseverance.

(1) Insanity is a protean disease. Its syndrome is subject to variation, and a grouping is not possible in all cases.

« ForrigeFortsæt »