- Email: [email protected]
PROFESSIONAL RESPONSIBILITY IN CASES OF MENTAL UNSOUNDNESS.
1557
category of the weak-minded it is evident that a fuller knowledge of their origin and character, which may lead to efficient methods of protecting the community against their
ill-doing,
must be of very real interest and
importance.
From this point of view the observations of Dr. SMALLEY on the question are deserving of very serious consideration as the expression of a ripe and cautious judgment founded on wide experience. The weak-minded criminals of the type which we have indicated are, Dr. SMALLEY tells us, for the most part recidivists. Beginning their penal career at a relatively early age, generally about the period of adolescence, when they are forced to enter on the struggle for existence for which they are so heavily handicapped by their defective organisation, they continue through the rest of their lives to oscillate between the prison, the asylum, and the
workhouse, with brief intervals of freedom, during which they can be more actively noxious. Ordinarily the
of a relatively trivial often rather sins of social character, being, indeed, very omission than acts really meriting the name of crime. This general rule, however, is subject to many and grave exceptions. The feebleness of mind which renders these defectives incapable of sustained effort and of due adaptation to environment drives them to parasitic ways of life, while it involves a lack of self-control which leaves their offences which
they
commit
are
conduct at the mercy of every casual impulse of unusual intensity. An outburst of lust will provoke them to rape or bestiality, or an exaggerated sense of injury aroused by some trivial incident will impel them to wreak their vengeance in murder or arson. The number of the criminal
defectives of this lowest class is not, it would appear from the available records, very large. The official figures for the last three years put it at 1090, and this would probably include some instances in which the same individual was counted more than once. When it is further borne in mind that a not inconsiderable share of this total is made up of cases of senile and alcohelic dementia and other forms of enfeeblement which are rather inert and helpless than actively mischievous, it will be that the group may be reduced to even more moderate proportions. On this fact of their relatively small number, taken in conjunction with the extent and variety of their seen
activities, Dr. SMALLEY is able to found a convincing argument in favour of dealing with these weak-
anti-social
minded offenders on special lines. The expense that would be incurred by their permanent detention in a suitable institution would, he points out, be covered, at least in part, by the saving of the cost now involved in repeatedly prosecuting them and maintaining them in prison. Moreover, it is possible that under a course of continuous and appropriate training which would develop whatever manual aptitudes they possess-and in many cases these aptitudes are considerable-they could be made to contribute in some measure to their own support. In any circumstances there can be no question as to the advantage that would accrue to the community from the substitution of such a scheme as Dr. SMALLEY suggests for the present system, which is not only expensive and cumbrous but which fails completely to secure what should be its first aim, the adequate
protection
of
society.
Annotations. "Ne quid nimil."
PROFESSIONAL RESPONSIBILITY IN CASES OF MENTAL UNSOUNDNESS. THE care and management of individuals whose mental processes are abnormal but who do not necessarily at any time exhibit derangement of sufficient degree to call for seclusion, constitute one of the most difficult and delicate problems with which medical men have to deal. Since such persons commonly spring from neurotic stock, exhibiting a history of insanity or of disorders allied therewith, the duty of the parents-a duty which, it is to be hoped, is becoming more widely recognisedis to communicate to their medical adviser all information relating to their family history which it is in their power to give, in order that the tainted individual may from early childhood be safeguarded as far as possible against the risks to which he is exposed. Broadly speaking, the aim in such cases will be to provide for the child individual care and training, having due regard to the mental and physical aspects of education. The degree and kind of mental work and relaxation and of physical exercise have to be determined and a suitable teacher and playmates selected. It is not seldom advisable te remove such children from home care-where, by reason of mental instability on the part of a parent or relative, the environment is unfavourable -to family care as provided by competent strangers. Later will arise the question of selecting a suitable school where adequate individual attention can be relied upon and the requisite medical and other supervision can be exercised. The dangers associated with the development of the sexual instinct have to be reckoned with, for the neurotic individual at the age of puberty is prone to develop sexual malpractices. Solitude is unfavourable to such persons. The subsequent choice of a career will be largely deter mined by the general consideration that persons mentally unstable are best suited by occupations of a regular kind with all possible freedom from anxiety and responsibilityoccupations, in brief, which involve a minimum of mental strain and allow ample opportunity for an outdoor existence. Unfortunately, the inordinate mental activity of many of these people renders such occupations irksome. The question of the marriage of psychois one upon which the advice of£ individuals pathic medical men is asked and is likely, with the increase of education, to be more widely sought. Probably such advice is at present asked mainly, if not wholly, from the point of view of the benefit of the individual, but we may assuredly with some confidence hope that in these matters the welfare of posterity will be a consideration of increasing importance. This is but a phase of the question of prophylaxis, and in all that pertains to the prevention of disease there cannot fail to be a growing tendency on the part of an intelligent public to recognise the authority and abide by the advice of the physician, for whom therefore the future should hold increasing influence and responsibility. It is also probable that medical authority will come to count for more in those medico-legal issues to which the actions of the mentally defective give rise, such actions as those to which the unhappy subject of the imperative idea, or the individual who illustrates one of the many phases of sexual perversion, is liable. It is inconceivable that the law should continue to regard as fully responsible the individual who, whilst his conduct is abnormal, can be shown to exhibit the outward and visible signs of defective development, in the shape of the so-called ’’ stigmata" and of mensural deviations from a normal
1558 standard, and whose history can be adduced as evidence severely punished. Every house in Panama was di,-?that the stock from which,hesprings is degenerate. But infected, stringent measures were taken for the early rethe onus of proving this, the duty’of seeming by persistent cognition of cases, and every inhabitant of the city was . representation and scientific demonstration that justice inspected by a physician once a day. Further, mosqaitobe done to these unfortunates, lies with the medical breeding places were actively treated ; all water tanks, profession. A furthur illustration of the manner in which cisterns, and the like were cleaned and covered in pending med’cal men may be brought into contact with persons whose the completion of works for a water-supply which should do mental balance is disturbed is furnished by those cases away with such cisterns. The city is now two-thirds sewered *in which the ability of such individuals to control them- and the streets are being paved with vitrified bricks. Now In May there were, as has been said, 3& selves or their affairs is called in question; and in dealing for the results. with these there is need for great circumspection. The cases of yellow fever ; in June this number had risen to 62. Lunacy Law protects the medical man who acts in good Then Governor Magoon’s legislation and the health authorifaith and ’with reasonable care, but it is very necessary to ties’ action began to show results and in July the number afford no grounds for asserting negligence in these respects ; of cases sank to 42 ; in August there were 27, in September more especially is it advisable to have at the time of the only six, and with this came the end of the yellow inquiry full personal knowledge, as distinct from mere com- fever. The last case in Colon occurred on August 27th municated information, of the conduct and actions of the and the last in Panama on Sept. 14th. So certain are the individual whom it is sought to deprive of his personal authorities that the disease has been stamped out that a liberty or rights. The legal procedure of the " inquisi- notice signed by Governor Magoon and Colonel Gorgas has ’tion " applies to these cases and the law is set in motion by been posted offering to any person not a member of the health department who shall notify a case of yellow fever means of a petition presented commonly by the husband in Panama, Colon, or the Canal Zone a sum of$50 in gold or wife or a near relative of the individual in question, between the dates of Oct. 2nd and Dec. lst, 1905. The supported by medical affidavits. In such inquiries the letter from which we have quoted is extremely interesting the benefit and protecprimary aim of the law is to secure a both from the and who is the of tion of the person sanitary point of view and as showing what inquisition subject it is therefore prudent for the medical man to take the same can be done by methods employed in a democratic country. standpoint, since the interests of the affected individual If we had a Governor Magoon over here to deal with vaccination as he has done with yellow fever, small-pox would most are not always identical with those of his relatives, and are still less likely to be compatible with those of strangers. likely be a thing of the past. The latter may, in quite exceptional circumstances, be justified in intervening, but it would, as a rule, be imprudent LONDON TRAFFIC. to act in association with strangers in these circumstances. THE proposed central traffic board for London when it comes into existence will find itself confronted with a task in comparison with which the labours of Sisyphus may be reSANITATION AND THE PANAMA CANAL. garded as mere diversion. All thoughtful students of the subIN the month of June we published a series of articles ject are agreed that the real problem to be grappled with is dealing with the sanitation of the Panama Canal as regards not so much the regulation of the traffic, however necessary the period ending 1904. In the last article of the series the this may be, but its limitation. The London County Council writer, Mr. John George Leigh, expressed his opinion that has done much to improve and to expand the thoroughfares in the preliminary campaign against climate and disease the of the metropolis, yet the widening of streets, often carried American authorities had sustained a regrettable repulse. out at infinite cost, is but the treatment of a symptom, nay, He continued : ’’ That they will eventually conquer is equally it oftentimes aggravates the disorder which it attempts to certain and the more decisive the victory is the more control. The increased accommodation provided in the lofty permanent should be its results." How true was this structures which supersede the smaller original buildings, prophecy is shown by a letter which is published in the whether used as places of amusement, business, or resiTimes of Nov. 20th "From a Correspondent." This writer dential flats, tends eventually to increase the traffic by says that up to May of this year Colonel W. C. Gorgas, who attracting a larger population to the district and affords athad freed Havana from yellow fever, was almost helpless the best only temporary relief. The London County Council in the bonds of red tape. President Roosevelt there- in its paternal care for the welfare of its charges has entered his own on responsibility, without the leave of Con- factories and concerned itself in the sanitary well-being upon the old Canal Commissioners to resign, of the workers and in the proper provision for the means gress, compelled filled their place with new men, and appointed as of escape in case of fire. It has in the present question Governor of the Canal Zone Judge Charles E. Magoon a mammoth undertaking calculated to satisfy the ambition He arrived at the end of of its most progressive member and one which if properly with autocratic power. May, during which month there had been 38 cases dealt with would not only improve the health of the comHe found that many members of the munity at large but might eventually add to our capaof yellow fever. to bear an increased taxation by supplying new American colony had fallen into a state of bravado and and vigour to the working population. In place was transmission conhealth of that the mosquito theory argued of had rules which not the that would and overcrowding in the already congested encouraging obey they temptuous been formulated. They let themselves be bitten by mos- centres the removal of some of the hives of industry quitoes and tore holes in the nettings or destroyed them. into healthier and more open surroundings, where those Governor Magoon promptly admitted that he was afraid of engaged could live within easy access of their work and catching yellow fever and, moreover, he remarked that any under more hygienic conditions, would be invaluable to non-immune person who professed to be not afraid was all ; the hospitals, workhouses, and infirmaries would be either a fool cr a knave and should be treated as s1ilch. He relieved of many of their present inmates and a vast amount also said that the mosquito theory was upheld by the of unnecessary suffering would be averted. In som thickly best medical and surgical authorities and that therefore populated districts there are certain very unhealthy trades he believed in it and meant to enforce it. All window injurious alike to those concerned and to those living nettings were replaced and a proclamation was issued in the neighbou.rhood, the evils associated with which, that anyone who removed or tore themshould be if not entirely obviated, would be greatly mitigated by
bility
’
category of the weak-minded it is evident that a fuller knowledge of their origin and character, which may lead to efficient methods of protecting the community against their
ill-doing,
must be of very real interest and
importance.
From this point of view the observations of Dr. SMALLEY on the question are deserving of very serious consideration as the expression of a ripe and cautious judgment founded on wide experience. The weak-minded criminals of the type which we have indicated are, Dr. SMALLEY tells us, for the most part recidivists. Beginning their penal career at a relatively early age, generally about the period of adolescence, when they are forced to enter on the struggle for existence for which they are so heavily handicapped by their defective organisation, they continue through the rest of their lives to oscillate between the prison, the asylum, and the
workhouse, with brief intervals of freedom, during which they can be more actively noxious. Ordinarily the
of a relatively trivial often rather sins of social character, being, indeed, very omission than acts really meriting the name of crime. This general rule, however, is subject to many and grave exceptions. The feebleness of mind which renders these defectives incapable of sustained effort and of due adaptation to environment drives them to parasitic ways of life, while it involves a lack of self-control which leaves their offences which
they
commit
are
conduct at the mercy of every casual impulse of unusual intensity. An outburst of lust will provoke them to rape or bestiality, or an exaggerated sense of injury aroused by some trivial incident will impel them to wreak their vengeance in murder or arson. The number of the criminal
defectives of this lowest class is not, it would appear from the available records, very large. The official figures for the last three years put it at 1090, and this would probably include some instances in which the same individual was counted more than once. When it is further borne in mind that a not inconsiderable share of this total is made up of cases of senile and alcohelic dementia and other forms of enfeeblement which are rather inert and helpless than actively mischievous, it will be that the group may be reduced to even more moderate proportions. On this fact of their relatively small number, taken in conjunction with the extent and variety of their seen
activities, Dr. SMALLEY is able to found a convincing argument in favour of dealing with these weak-
anti-social
minded offenders on special lines. The expense that would be incurred by their permanent detention in a suitable institution would, he points out, be covered, at least in part, by the saving of the cost now involved in repeatedly prosecuting them and maintaining them in prison. Moreover, it is possible that under a course of continuous and appropriate training which would develop whatever manual aptitudes they possess-and in many cases these aptitudes are considerable-they could be made to contribute in some measure to their own support. In any circumstances there can be no question as to the advantage that would accrue to the community from the substitution of such a scheme as Dr. SMALLEY suggests for the present system, which is not only expensive and cumbrous but which fails completely to secure what should be its first aim, the adequate
protection
of
society.
Annotations. "Ne quid nimil."
PROFESSIONAL RESPONSIBILITY IN CASES OF MENTAL UNSOUNDNESS. THE care and management of individuals whose mental processes are abnormal but who do not necessarily at any time exhibit derangement of sufficient degree to call for seclusion, constitute one of the most difficult and delicate problems with which medical men have to deal. Since such persons commonly spring from neurotic stock, exhibiting a history of insanity or of disorders allied therewith, the duty of the parents-a duty which, it is to be hoped, is becoming more widely recognisedis to communicate to their medical adviser all information relating to their family history which it is in their power to give, in order that the tainted individual may from early childhood be safeguarded as far as possible against the risks to which he is exposed. Broadly speaking, the aim in such cases will be to provide for the child individual care and training, having due regard to the mental and physical aspects of education. The degree and kind of mental work and relaxation and of physical exercise have to be determined and a suitable teacher and playmates selected. It is not seldom advisable te remove such children from home care-where, by reason of mental instability on the part of a parent or relative, the environment is unfavourable -to family care as provided by competent strangers. Later will arise the question of selecting a suitable school where adequate individual attention can be relied upon and the requisite medical and other supervision can be exercised. The dangers associated with the development of the sexual instinct have to be reckoned with, for the neurotic individual at the age of puberty is prone to develop sexual malpractices. Solitude is unfavourable to such persons. The subsequent choice of a career will be largely deter mined by the general consideration that persons mentally unstable are best suited by occupations of a regular kind with all possible freedom from anxiety and responsibilityoccupations, in brief, which involve a minimum of mental strain and allow ample opportunity for an outdoor existence. Unfortunately, the inordinate mental activity of many of these people renders such occupations irksome. The question of the marriage of psychois one upon which the advice of£ individuals pathic medical men is asked and is likely, with the increase of education, to be more widely sought. Probably such advice is at present asked mainly, if not wholly, from the point of view of the benefit of the individual, but we may assuredly with some confidence hope that in these matters the welfare of posterity will be a consideration of increasing importance. This is but a phase of the question of prophylaxis, and in all that pertains to the prevention of disease there cannot fail to be a growing tendency on the part of an intelligent public to recognise the authority and abide by the advice of the physician, for whom therefore the future should hold increasing influence and responsibility. It is also probable that medical authority will come to count for more in those medico-legal issues to which the actions of the mentally defective give rise, such actions as those to which the unhappy subject of the imperative idea, or the individual who illustrates one of the many phases of sexual perversion, is liable. It is inconceivable that the law should continue to regard as fully responsible the individual who, whilst his conduct is abnormal, can be shown to exhibit the outward and visible signs of defective development, in the shape of the so-called ’’ stigmata" and of mensural deviations from a normal
1558 standard, and whose history can be adduced as evidence severely punished. Every house in Panama was di,-?that the stock from which,hesprings is degenerate. But infected, stringent measures were taken for the early rethe onus of proving this, the duty’of seeming by persistent cognition of cases, and every inhabitant of the city was . representation and scientific demonstration that justice inspected by a physician once a day. Further, mosqaitobe done to these unfortunates, lies with the medical breeding places were actively treated ; all water tanks, profession. A furthur illustration of the manner in which cisterns, and the like were cleaned and covered in pending med’cal men may be brought into contact with persons whose the completion of works for a water-supply which should do mental balance is disturbed is furnished by those cases away with such cisterns. The city is now two-thirds sewered *in which the ability of such individuals to control them- and the streets are being paved with vitrified bricks. Now In May there were, as has been said, 3& selves or their affairs is called in question; and in dealing for the results. with these there is need for great circumspection. The cases of yellow fever ; in June this number had risen to 62. Lunacy Law protects the medical man who acts in good Then Governor Magoon’s legislation and the health authorifaith and ’with reasonable care, but it is very necessary to ties’ action began to show results and in July the number afford no grounds for asserting negligence in these respects ; of cases sank to 42 ; in August there were 27, in September more especially is it advisable to have at the time of the only six, and with this came the end of the yellow inquiry full personal knowledge, as distinct from mere com- fever. The last case in Colon occurred on August 27th municated information, of the conduct and actions of the and the last in Panama on Sept. 14th. So certain are the individual whom it is sought to deprive of his personal authorities that the disease has been stamped out that a liberty or rights. The legal procedure of the " inquisi- notice signed by Governor Magoon and Colonel Gorgas has ’tion " applies to these cases and the law is set in motion by been posted offering to any person not a member of the health department who shall notify a case of yellow fever means of a petition presented commonly by the husband in Panama, Colon, or the Canal Zone a sum of$50 in gold or wife or a near relative of the individual in question, between the dates of Oct. 2nd and Dec. lst, 1905. The supported by medical affidavits. In such inquiries the letter from which we have quoted is extremely interesting the benefit and protecprimary aim of the law is to secure a both from the and who is the of tion of the person sanitary point of view and as showing what inquisition subject it is therefore prudent for the medical man to take the same can be done by methods employed in a democratic country. standpoint, since the interests of the affected individual If we had a Governor Magoon over here to deal with vaccination as he has done with yellow fever, small-pox would most are not always identical with those of his relatives, and are still less likely to be compatible with those of strangers. likely be a thing of the past. The latter may, in quite exceptional circumstances, be justified in intervening, but it would, as a rule, be imprudent LONDON TRAFFIC. to act in association with strangers in these circumstances. THE proposed central traffic board for London when it comes into existence will find itself confronted with a task in comparison with which the labours of Sisyphus may be reSANITATION AND THE PANAMA CANAL. garded as mere diversion. All thoughtful students of the subIN the month of June we published a series of articles ject are agreed that the real problem to be grappled with is dealing with the sanitation of the Panama Canal as regards not so much the regulation of the traffic, however necessary the period ending 1904. In the last article of the series the this may be, but its limitation. The London County Council writer, Mr. John George Leigh, expressed his opinion that has done much to improve and to expand the thoroughfares in the preliminary campaign against climate and disease the of the metropolis, yet the widening of streets, often carried American authorities had sustained a regrettable repulse. out at infinite cost, is but the treatment of a symptom, nay, He continued : ’’ That they will eventually conquer is equally it oftentimes aggravates the disorder which it attempts to certain and the more decisive the victory is the more control. The increased accommodation provided in the lofty permanent should be its results." How true was this structures which supersede the smaller original buildings, prophecy is shown by a letter which is published in the whether used as places of amusement, business, or resiTimes of Nov. 20th "From a Correspondent." This writer dential flats, tends eventually to increase the traffic by says that up to May of this year Colonel W. C. Gorgas, who attracting a larger population to the district and affords athad freed Havana from yellow fever, was almost helpless the best only temporary relief. The London County Council in the bonds of red tape. President Roosevelt there- in its paternal care for the welfare of its charges has entered his own on responsibility, without the leave of Con- factories and concerned itself in the sanitary well-being upon the old Canal Commissioners to resign, of the workers and in the proper provision for the means gress, compelled filled their place with new men, and appointed as of escape in case of fire. It has in the present question Governor of the Canal Zone Judge Charles E. Magoon a mammoth undertaking calculated to satisfy the ambition He arrived at the end of of its most progressive member and one which if properly with autocratic power. May, during which month there had been 38 cases dealt with would not only improve the health of the comHe found that many members of the munity at large but might eventually add to our capaof yellow fever. to bear an increased taxation by supplying new American colony had fallen into a state of bravado and and vigour to the working population. In place was transmission conhealth of that the mosquito theory argued of had rules which not the that would and overcrowding in the already congested encouraging obey they temptuous been formulated. They let themselves be bitten by mos- centres the removal of some of the hives of industry quitoes and tore holes in the nettings or destroyed them. into healthier and more open surroundings, where those Governor Magoon promptly admitted that he was afraid of engaged could live within easy access of their work and catching yellow fever and, moreover, he remarked that any under more hygienic conditions, would be invaluable to non-immune person who professed to be not afraid was all ; the hospitals, workhouses, and infirmaries would be either a fool cr a knave and should be treated as s1ilch. He relieved of many of their present inmates and a vast amount also said that the mosquito theory was upheld by the of unnecessary suffering would be averted. In som thickly best medical and surgical authorities and that therefore populated districts there are certain very unhealthy trades he believed in it and meant to enforce it. All window injurious alike to those concerned and to those living nettings were replaced and a proclamation was issued in the neighbou.rhood, the evils associated with which, that anyone who removed or tore themshould be if not entirely obviated, would be greatly mitigated by
bility
’