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distress us with elaborate re-discoveries of anatomical and physiological details known long ago, or with still more elaborate corrections of the casual or unavoidable omissions of some brief or condensed Text-book of the science. Many of these amusing authors disport themselves in a region where we must not attempt to reach them. Thus, the amiable and considerate writer who a few months ago blandly suggested castration as a remedy for phthisis, claimed the judicial notice of our Surgical colleague, for a sentence, let us hope, not analogous to that of Phalaris. And the American author who lately deduced the infectiousness of tetanus from what seems to a common mind a case of over-poisoning of a bullock with strychnia by some negroes actuated by a natural (but indiscreet) yearning after fresh meat, might be fitly left to the criticism. of our Toxicological friends. But writers of Physiological Essays will, it is hoped, take it as a friendly hint if we suggest that, before rushing into print with new and brilliant discoveries, they look into the pages of what we must, for years to come, regard as the text-book of British Physiology; or at any rate, if they choose to teach, before they have learnt, the subject, to recollect that these volumes may at any moment supply a bitter and unsparing (because true and impassive) criticism. With the utterance of this mysterious warning and strong inducement to a large class of apparently wealthy writers, we feel that we complete our duty alike to them and to the publishers; who are quite entitled to expect a large and rapid sale for what is as incomparably the best, as it certainly is the cheapest, scientific work of the day-a work indispensable to the Physiologist, and scarcely less so to the Physician.

REVIEW VIII.

First Annual Report of the General Board of Commissioners in Lunacy for Scotland. Presented to both Houses of Parliament by command of Her Majesty.

THERE is always some danger when there is an acknowledged abuse to remedy, that the authorities put in motion to accomplish the object will set about their task with more zeal than discretion, and that while they are directing their attention to the magnitude of the evils which have called for their interference, they will overlook the reasonable claims to consideration to which those are entitled who, though themselves parties to a most objectionable state of things, cannot fairly be held responsible for them, but must rather be regarded as accidentally committed to a vicious system, from which it would have been very difficult for them to have escaped, and which it may be charity to suppose they never saw in its true light.

Considering, then, the deplorable condition of a large proportion of the insane in Scotland, as disclosed by the Report of the Royal Commissioners, it is very satisfactory to find that the General Board of Commissioners in Lunacy for Scotland, appointed under the 20th and 21st Vict. cap. 71, have approached the subject with singular freedom from prejudice, and have more than justified their appointment by their first report, admirable alike for its tone and temper, for the valuable in

formation it affords, for the evidence of the patient industry which has been brought to bear upon a very arduous and difficult task, and for the dispassionate and candid manner in which all the facts have been weighed.

Nothing is so calculated to ensure the hearty co-operation of those whose proceedings it will be their duty to supervise, as that feeling of confidence in their discretion and fairness which is inspired by the first Report of the Scotch Commissioners, and which we doubt not will characterize their future proceedings. The results of good government will always be found in the sincere devotion of those who are governed, and we feel sure that the spirit in which these Commissioners have inaugurated their reign is calculated materially to lessen the difficulties which are inseparable from the establishment of a new régime.

One of the first difficulties which the Commissioners encountered was the correct reading of the Act under which their powers were granted. This, in fact, affords another illustration of the almost impossibility experienced by legislators in making laws so to word them that they are sure in the hands of candid administrators to carry out their own views and intentions. The value attaching to expressions and words so frequently admits of question, that we can scarcely be surprised if in dealing with insanity (a subject about which even the best informed know so little) our lawgivers should fail in the attempt to convey their precise meaning, and that further legislation should be required to define the powers intended to be given to the Commis

sioners.

In the words of the Report,

"The chief objects of the statute are to provide for the building of district asylums for the reception of pauper lunatics, and to insure the proper care and treatment of lunatics generally, whether placed in asylums or left in private houses under the care of relatives or strangers."

It appears here to be assumed that all the world is agreed as to what is "a lunatic," and that consequently no doubt can arise as to the persons who may be properly subjected to this care and treatment; but lest there should be any question in particular cases, an attempt is made to define, for the purposes of the Act, the condition of mind implied by the term "lunatic," and, as usual with all such attempts, the matter is left in as much uncertainty as ever. The Commissioners make the following observations on the statutory definition of lunacy.

"The word 'lunatic,' the Statute declares, 'shall mean and include any mad or furious or fatuous person, or person so diseased or affected in mind as to render him unfit in the opinion of competent medical persons to be at large, either as regards his own personal safety and conduct, or the safety of the persons and property of others or of the public.' The question here arises, whether the second part of the definition is simply explanatory of the first part, or whether it is an amplification of the definition; whether, namely, every mad, fatuous, or furious person is simpliciter a lunatic, or whether to be so accounted he must also be unfit to be at large, as regards his own safety and conduct, or the safety and property of the public. It may further be considered doubtful whether it is contemplated that a person, in order to be

declared lunatic, must be unfit to be at large as regards both his own safety and conduct, or as regards both the safety and property of the public, or whether the definition will be fulfilled if he be unfit to be at large, as regards either his own safety or conduct, or as regards either the safety or property of the public. In practice, the view has generally been adopted, that every person certified to be of unsound mind is, in the statutory sense, a lunatic; but the Board of Supervision appear to be of opinion that no pauper of unsound mind can be considered a lunatic in terms of the Statute, unless there is also reason to apprehend danger. In accordance with this view, it has on various occasions been maintained not only by parochial boards, but also by sheriffs, that fatuous or idiotic paupers, although totally incapable from mental deficiency of acting for themselves, are not lunatics in terms of the Act. The question, therefore, is one of great practical importance, and its early adjustment is extremely desirable."

We think it would have been much more to the purpose if the Act had either constituted some independent authority to determine doubtful cases, or had given to the Commissioners absolute power to declare within a certain time after the patient had been placed under control, whether or not it was a proper case for such control. It is impossible, from the infinite peculiarities of human nature to define what is natural and what is unnatural in an individual. All the circumstances of constitution, temperament, disposition, habits, occupation, means, health, &c. &c., must be carefully weighed in each case, before a correct judgment can be formed as to the mental condition of any person; it is therefore utterly useless to set up any standard of sanity by which all can be equally measured, and equally useless to attempt a legal definition of that which must necessarily often be a matter of opinion. Natural sympathy for the insane has engendered a feeling of suspicion and distrust towards all persons, whether medical or otherwise, who have to deal with them; and we regret to see unworthy motives unhesitatingly attributed to any medical man who, in the ordinary exercise of his profession, signs a certificate of insanity; whilst those to whose care a patient is entrusted are frequently from this fact only, and without any other ground, denounced as mercenary and dishonourable, without any higher aim than their own pecuniary benefit, regardless alike of the rights and welfare of their unfortunate patients, and of their own character and reputation. One might suppose that the existence of insanity was discredited, and that the mass of the people regarded it as a delusion attempted to be palmed upon them by those who were professionally engaged in its treatment; that, in fact, if there were really such a malady, it was only present when furious maniacal excitement existed, and that when a patient was capable of conducting a rational conversation he could not be insane. He may be mistaken as to facts; he may make an error in judgment, he may reason incorrectly, he may have firm belief in the existence of that of which others see no evidence; but still, it is argued, this does not constitute insanity; and as to extravagant and violent conduct, he may be eccentric, and, under the provocation of interference may give way to a naturally irritable and hasty temperbut still the lawyers will say triumphantly, this is not madness.

But who is to decide? Doctors are suspected, commissioners are ignored, and the duty of determining upon what shall be done in a doubtful case devolves upon whoever is rash enough to take the responsibility on himself, and to risk the consequences of a contrary opinion on the part of a jury who, without any experience whatever, are alone recognised by the law as competent to judge. It seems to us that it would be quite as rational to submit to the decision of a non-professional jury, guided by the evidence of non-professional persons, a question as to the existence of disease in a patient's lungs, liver, or kidneys, at some period antecedent to the inquiry, as to suppose that juries as at present constituted can properly judge of the symptoms of mental unsoundness said to have existed weeks or months previously. There is perhaps no question which more requires the nice discrimination of skilled observers, and none in which such assistance is so entirely disregarded. Can it be, then, that we have been all along deceived as to the existence and nature of this malady, and that the overgrown and costly receptacles for the insane which during the last thirty years have been springing up in every county, and adding so grievously to the burdens of the ratepayers, are in fact as unnecessary as they are oppressive? Notwithstanding the indisposition to recognise insanity, especially in its early stages and mildest forms, we are disposed to believe that even English juries would agree that the thousands who people our asylums are really of unsound mind, and need protection and care. If, then, so large a proportion of the population is really insane, it is surely the first duty of the Legislature to constitute some independent and competent authority to determine what persons can properly and legally be detained under care and treatment. The interests of the insane themselves, not less than of society, require that the responsibility of their detention should not devolve upon their friends, who are thereby frequently deterred from taking those prompt measures upon which the issue of the case so often depends, and so the chance of recovery is lost. If it is right that an insane person should be controlled, there is no reason why the odium of placing him under control should rest upon his relatives; society is interested in his protection and recovery, and the State may therefore very properly be charged with the duty of determining by its proper officers in what cases it is necessary to interpose its authority.

The Act 20 and 21 Vict., cap. 71, provides for the appointment of district medical inspectors; but it appears that no such appointments have yet been made; the Commissioners, however, in speaking of them, say, "We have repeatedly had occasion to feel the want of their services, especially in the case of lunatics whose removal to an asylum appeared to us to be desirable, but in regard to whom a different opinion was strenuously maintained by the parochial authorities." To such officers as these district medical inspectors might very properly be delegated the duty of signing all certificates of insanity, one provisional certificate of any legally qualified medical practitioner being in the interim sufficient authority to take such steps as the urgency of the case required. We have already said that in the interests of

society, and of the patients themselves, it is most important that the responsibility of confining or detaining them should not rest with their relatives, neither should it devolve on those who have an interest in continuing their detention; and as it seems that that impracticable animal, "the public," is not satisfied with the protection of two medical certificates, by all means give more, and provide a sufficient number of well paid and responsible officers to examine every patient before admission into an asylum. In Scotland, the duty of granting an order is performed by the sheriff; but he, not being a medical man, occasionally refuses to sanction the confinement of a patient, because he cannot see with the eye of an experienced practitioner. The Commissioners quote several cases where the sheriff's order was refused, and after remarking,

"That the best hope of recovery lies in early treatment, and therefore that it is of the greatest consequence to the welfare of a patient that his reception into an asylum should as much as possible be facilitated:"

They say:

"We are clearly of opinion, that less evil is likely to result from the sheriff accepting as proof of insanity the certificates to this effect of two qualified medical men, and attaching comparatively little weight to the facts quoted by them as evidence of its existence: than from his refusing to attach any value to these certificates, and founding his decisions on the statements of facts which reach him at second hand, from the very men whom personal examination convinced of the existence of mental aberration. A medical man may, from the manner, appearance, and conduct of a patient, be thoroughly convinced of his insanity, and may nevertheless fail, by any statement of facts, to convey the same conviction to another person; and this difficulty will be greatest in the incipient stages of the malady, at the very time when asylum treatment is calculated to be most beneficial."

The necessity that exists for the appointment of independent and competent judges in all cases of insanity, is shown by the fact, set forth in this Report, that the Commissioners have been unable to obtain from ordinary medical practitioners the necessary certificates for the removal of patients to asylums, who, in their judgment, ought to be placed there under care and treatment. Surely the Commissioners should have authority in such cases, if not, some other power should be constituted which should insure something like uniformity of action. It is lamentable to think that the imaginary protection given to lunatics should operate in opposing an insuperable barrier to the proper treatment of their malady at its most critical period, by sacrificing the most valuable time in attempts to reconcile conflicting opinions and overcome the prejudices of those in whose hands the law has left the fate of the patient. We quote from the Report the following remarks:

"The cases in which the objection of medical men to grant certificates of insanity acted in preventing us from improving the condition of pauper lunatics, were not very numerous. Still, from the important consequences involved, we think it right to advert to them. We have pointed out that, by the Statute, pauper lunatics shall be sent to the asylum of the district in which the parish of the pauper is situated, unless the Board agree to their disposal otherwise. But the statutory form of the medical certificate of insanity required to

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