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Lunacy and the Law.
1473 ’unless a sufficiently high standard of suitability is secured, indeed there is no real reason why the conditions of such places should not be required to approximate to those of Lest it should be considered ’bakehouses above ground. that we are asking for the attainment of the imprac-
WILLIAM R. GOWERS made a vigorous and effective appeal behalf of a class of cases of mental disorder which
on
i from every standpoint are difficult to deal with. We do not quite understand what Sir WILLIAM GOWERS means
when he states that there is an " absolute divorce between the treatment of insanity and general medicine," but he is refer to a document which has been ticable, may Medicala neurologist of distinction who, although not regarding - drawn up by the Incorporated Society of ] as a member of the medico-psychological body of - Officers of Health for the guidance of those whose himself has every right to be listened to on a subject advise authorities or it to will be ] justices practitioners, sanitary duty so allied to his own special sphere of work. as to the desirability of permitting existing underclosely Sir WILLIAM GOWERS points out that, to secure its objects, ground bakehouses to remain as such. The requirements the law has "decreed that all persons of unsound lunacy suggested by the society have not been hastily decided upon. mind shall be of deprived liberty, shall be stigmatised as They were first of all drafted by Dr. JAMES NIVEN, medical and shall be officer of health of Manchester, who approached the question insane, placed under the complete control of after having had considerable experience in the actual the Commissioners in Lunacy. No distinction is made, no .alteration of premises upon the lines which he laid down,discrimination is permitted ; all forms and degrees of and they were then discussed and re-discussed, altered, and mental unsoundness must so far be treated alike....... amended by a large representative committee consisting One principle, and only one, determined the incidence of members of the society from all parts of the country. of the law-whether the care of the patient was paid for." Finally they were considered at a full meeting of the Speaking in this connexion Sir WILLIAM GOWERS has some society held on Nov. 21st and they may now be looked upon hard things to say of the resulting evils in incipient and we
majority of British medical transient cases, and in border-line cases as to the import These suggestions cannot fail to be of of which any two authorities might possibly dieagree. The officers of health. service to those for whom they are intended and in no sense few instances which he relates out of many serve to bring his conviction, and the occasion for its growth, into strong can exception be taken to any of the requirements on the relief, if, indeed, they do not rather indicate that he has score of extravagance or because they are uncalled for or shown a tendency to overstate his case and to underimpossible of execution. the the of are that all Briefly proposals society underground estimate the position in which the law finds itself. The bakehouses shall be at least eight feet in height or eight machinery of the lunacy law was never constructed to deal feet six inches where the fioor area exceeds 300 square feet. with simple and incipient deviations from sanity, or with The walls and floors shall be constructed of impervious transient delusions, or with"slight evanescent tendency to material and the ceilings shall be dust-proof, the light- suicide " ; and its forcible application in cases of this deing shall be such that a printed paper can ordinarily scription can only be likened, so far as harmful and disasbe read by daylight between the hours of 11 A M. trous effects are concerned, to the forcible blow of a Nasmyth and 3 P.M., and the ventilation shall be such that hammer upon a Barcelona nut. By the strong contrast Sir WILLIAM GOWERS no doubt scored a point. But many 3000 cubic feet of clean air can be supplied hourly for of who listened to the and who have had those address, each person employed, while the temperature of the room in the and of difficulties complications between the months of October and June shall not exceed large experience have of adduced plenty instances where 80° F. Other very proper requirements are that there shall lunacy practice, could be free access to sanitary conveniences and to conveniences delay in recognising the serious nature of the indications of for personal ablution and that there shall be provision for mental unsoundness, where temporising and indecision, depositing wearing apparel elsewhere than in the bakehouse, where, in the matter of certification, a fatal acquiescence while a most essential requirement to promote adequate in the pleadings and susceptibilities of the patient or his cleansing of all parts of the bakehouse is the stipulation relatives, had led to results far more disastrous and irrethat all troughs, tables, or other furniture, standing on mediable than those referred to by Sir WILLIAM GOWERS being liable to occur in the patients on whose behalf the floor shall be moveable and provided with castors. he has raised his influential voice. There is, too, the The difficulties attending the compiling of a document of into which a person with disreputability such as we have been discussing are well known to anyone atmosphere or who becomes weak disordered means may mentally who has ever been engaged in the task of compilation and possibly drift, and which the law cannot allow itself we must congratulate the Incorporated Society of Medical Officers of Health upon the success which has attended their to overlook-unworthy relatives, unworthy solicitors, unlabours. We sincerely hope that no lower standard than that worthy medical men (alas), unworthy housekeepers and set by the society will be accepted by sanitary officials, by nurses, whose unscrupulousness has to be checkmated Surely the law has a right to detersanitary authorities, or by the justices when they are by anticipation. engaged in considering the fitness for occupation of an mine and to have sufficient guarantees that the patient’s money is spent properly and for his own best interests. underground room as a bakehouse. Again, many patients, especially melancholiacs, find relief r
as
expressing
the
opinions
of the
asI
Lunacy IN
his
recently appeared
address before the in
THE
and the Law.
Lunacy and the Law, delivered Medico-Psychological Association, which on
LANCET
of
Nov. 22nd, p. 1369,
Sir
and benefit in the fact that on certification their own weak and vacillating wills are officially replaced by the guidance of wills that inspire confidence by their strength and robustness. No consideration of the operative effects of th lunacy law, or of the environments in which its provision
1474 have to be carried out, can be regarded as complete which1 fails to give due weight to such points as these, as well1 as to the evils and risks that attend any informal orr happy-go-lucky dealing with persons of unsound mind. The nature of these evils and risks are best understoodl by those who have made insanity and the insane their life-study and who are therefore most likely to act warilyr
In pointing out some of the difficulties that appear to us to stand in the way of the realisation of any such utopian scheme of legal "reform"" as Sir WILLIAM GoWERS has
unfolded,
.
we
importance
of
have not the
looking
slightest wish to minimise the the question of what can
into
be done to legitimise the domestic treatment of cases of mental unsoundness in its earlier or what may be and to anticipate them. These are the’evils and risks byr termed its pre-certificate stages, so that the necessity which all sorts of social and domestic questions arefor certification and transfer to an asylum may, if complicated, and which the law has been striving, during: possible, be averted. Steps in this direction were actively i some few years ago by a joint committee of the the past half century of official and general experience taken --
progress in the study of insanity, toMedico-Psychological and British Medical Associations and , In omitting to make specific to avert. the most experienced minds were able to make important reference to their existence Sir -WILLIAM GOWERS scarcelysuggestions and proposals for dealing with the treatment did his subject justice ; and his hosts, on his plea that he of ( incipient cases. These suggestions met with the was not of their body, may have felt themselves justifiedapproval of the legal authorities and if they bad been
and of
pathological provide against and
--
in speaking to the subject-matters of the address uponmade i the subject of legal enactment they were calcuwhich there was agreement and in not being adversely lated I to place this class of patient on at least as satiscritical upon such an occasion. f a factory footing in England as in Scotland. The Sir WILLIAM GowERS denies that the enforcement of theprimary question of the liberty of the subject teaches law in the cases of mental unsoundness with which he is dealing is either necessary for the safety of the public or in
circumspection in dealing with individuals ; and if medical r men persist in treating irresponsible persons in a manner the interests of the patient. "Taken altogether," he says, copposed to the sanction of official authority they do so "the danger is very small in comparison with the dangerwith v their eyes open. We are not prepared to say how longand harm the law produces, directly and indirectly." We are ssuffering the public or the law ought to be on such a matter not so clear on the point as is Sir WILLIAM GowERS. What or c to what extent medical men or others are to be allowed assurance can there be in a new case that the stability of the t interfere with personal freedom under the guise of duty, to harmless nature of the symptoms will continue from day to ssympathy, or kindness, except on lines which it is for the 1 to determine and to indicate. day ?? And how can we tell that the class of cases which he law considers now to be wrongly dealt with by law will remain a reasonably constant quantity and will not be extended into a more dangerous type ?? In any case, if the danger is very small this is no doubt largely due to the fact that the law has been, and is being, enforced. And can anyone doubt Ne quid nimis." that if its provisions were materially relaxed the return to c
Annotations. "
old-time scandals and abuses would sooner or later follow ?? The essential hardship to which Sir WILLIAM GOWERS is
K KING
EDWARD’S HOSPITAL FUND FOR LONDON.
A MEETING of the General Council of this Fund for the of awarding grants to the hospitals was held at purpose anxious to direct attention is ’’ that the law compels the " Y York House, St. James’s, on Nov. 24th, H.R.H. the Prince compulsory certification, however needless or harmful, as a of of Wales being in the chair. The report showed that the condition for the skilled care which can only be obtained sum St available for distribution had been increased through His notification and tl to it by His Majesty the King of his subjects’ the transfer remedy by by payment." proposed coronation gift. The committee was thus able to advise limited certification is not likely to be accepted as meeting cc the distribution for the year of £100,000, recommending that the official requirements of the case, for a certificate tb the money should be devoted towards (1) the opening of to the effect that Mr. X. "is a person of unsound closed beds ; (2) the wiping out of debt; (3) building improvemind and is not a proper person to be detained"" m ments ; and (4) general maintenance. The Prince of Wales involves a contradiction in terms in the majority moved m the adoption of the report in an excellent speech in of cases such as those to which Sir WILLIAM GOWERS which wl he referred feelingly to the benefactions of His Majesty refers : for in most of them the impossibility of any longer the King, Mr. Samuel Lewis, Lard Strathcona, Lord Mountthe Maharaja of Sindhia, the Maharaja of Jaipur, St managing the individual in his ordinary domestic sur- Stephen, an and while he expressed his pleasure in learning that others, roundings has been the very cause of his removal to the Metropolitan Hospital Sunday Fund had been in no way the care of a stranger. What about the civil status and in injured by the great prosperity of the King’s Fund. The responsibilities of a person thus certificated ?? At whose motion was seconded by the Lord Mayor and adopted, the instance and by what authority is this removal to be m( meeting terminating with a vote of thanks to the His Royal Hi for presiding, which was proposed by Lord Rothbrought about if he does not go voluntarily ?? How many Higness seconded schild, be had such a scl by Rev. J. Guinness Rogers, and carried could detained after they patients perused
elth
th
in-
document, and what different effect would that they are of unsound mind have circumstances as compared with the certification under existing conditions! theory and practice here will seldom
parallel
lines.
the statement
upon them in these effect produced by
un unanimously.
-
PRISONERS AND SUSPENSE. ,
THE somewhat unusual and confused proceedings that ’ We much fear that ha, have taken place before the Liverpool stipendiary magisbe found to run on trate tra in the case of the man charged with causing the del death of Mr. Kensit have no doubt had their origin to
WILLIAM R. GOWERS made a vigorous and effective appeal behalf of a class of cases of mental disorder which
on
i from every standpoint are difficult to deal with. We do not quite understand what Sir WILLIAM GOWERS means
when he states that there is an " absolute divorce between the treatment of insanity and general medicine," but he is refer to a document which has been ticable, may Medicala neurologist of distinction who, although not regarding - drawn up by the Incorporated Society of ] as a member of the medico-psychological body of - Officers of Health for the guidance of those whose himself has every right to be listened to on a subject advise authorities or it to will be ] justices practitioners, sanitary duty so allied to his own special sphere of work. as to the desirability of permitting existing underclosely Sir WILLIAM GOWERS points out that, to secure its objects, ground bakehouses to remain as such. The requirements the law has "decreed that all persons of unsound lunacy suggested by the society have not been hastily decided upon. mind shall be of deprived liberty, shall be stigmatised as They were first of all drafted by Dr. JAMES NIVEN, medical and shall be officer of health of Manchester, who approached the question insane, placed under the complete control of after having had considerable experience in the actual the Commissioners in Lunacy. No distinction is made, no .alteration of premises upon the lines which he laid down,discrimination is permitted ; all forms and degrees of and they were then discussed and re-discussed, altered, and mental unsoundness must so far be treated alike....... amended by a large representative committee consisting One principle, and only one, determined the incidence of members of the society from all parts of the country. of the law-whether the care of the patient was paid for." Finally they were considered at a full meeting of the Speaking in this connexion Sir WILLIAM GOWERS has some society held on Nov. 21st and they may now be looked upon hard things to say of the resulting evils in incipient and we
majority of British medical transient cases, and in border-line cases as to the import These suggestions cannot fail to be of of which any two authorities might possibly dieagree. The officers of health. service to those for whom they are intended and in no sense few instances which he relates out of many serve to bring his conviction, and the occasion for its growth, into strong can exception be taken to any of the requirements on the relief, if, indeed, they do not rather indicate that he has score of extravagance or because they are uncalled for or shown a tendency to overstate his case and to underimpossible of execution. the the of are that all Briefly proposals society underground estimate the position in which the law finds itself. The bakehouses shall be at least eight feet in height or eight machinery of the lunacy law was never constructed to deal feet six inches where the fioor area exceeds 300 square feet. with simple and incipient deviations from sanity, or with The walls and floors shall be constructed of impervious transient delusions, or with"slight evanescent tendency to material and the ceilings shall be dust-proof, the light- suicide " ; and its forcible application in cases of this deing shall be such that a printed paper can ordinarily scription can only be likened, so far as harmful and disasbe read by daylight between the hours of 11 A M. trous effects are concerned, to the forcible blow of a Nasmyth and 3 P.M., and the ventilation shall be such that hammer upon a Barcelona nut. By the strong contrast Sir WILLIAM GOWERS no doubt scored a point. But many 3000 cubic feet of clean air can be supplied hourly for of who listened to the and who have had those address, each person employed, while the temperature of the room in the and of difficulties complications between the months of October and June shall not exceed large experience have of adduced plenty instances where 80° F. Other very proper requirements are that there shall lunacy practice, could be free access to sanitary conveniences and to conveniences delay in recognising the serious nature of the indications of for personal ablution and that there shall be provision for mental unsoundness, where temporising and indecision, depositing wearing apparel elsewhere than in the bakehouse, where, in the matter of certification, a fatal acquiescence while a most essential requirement to promote adequate in the pleadings and susceptibilities of the patient or his cleansing of all parts of the bakehouse is the stipulation relatives, had led to results far more disastrous and irrethat all troughs, tables, or other furniture, standing on mediable than those referred to by Sir WILLIAM GOWERS being liable to occur in the patients on whose behalf the floor shall be moveable and provided with castors. he has raised his influential voice. There is, too, the The difficulties attending the compiling of a document of into which a person with disreputability such as we have been discussing are well known to anyone atmosphere or who becomes weak disordered means may mentally who has ever been engaged in the task of compilation and possibly drift, and which the law cannot allow itself we must congratulate the Incorporated Society of Medical Officers of Health upon the success which has attended their to overlook-unworthy relatives, unworthy solicitors, unlabours. We sincerely hope that no lower standard than that worthy medical men (alas), unworthy housekeepers and set by the society will be accepted by sanitary officials, by nurses, whose unscrupulousness has to be checkmated Surely the law has a right to detersanitary authorities, or by the justices when they are by anticipation. engaged in considering the fitness for occupation of an mine and to have sufficient guarantees that the patient’s money is spent properly and for his own best interests. underground room as a bakehouse. Again, many patients, especially melancholiacs, find relief r
as
expressing
the
opinions
of the
asI
Lunacy IN
his
recently appeared
address before the in
THE
and the Law.
Lunacy and the Law, delivered Medico-Psychological Association, which on
LANCET
of
Nov. 22nd, p. 1369,
Sir
and benefit in the fact that on certification their own weak and vacillating wills are officially replaced by the guidance of wills that inspire confidence by their strength and robustness. No consideration of the operative effects of th lunacy law, or of the environments in which its provision
1474 have to be carried out, can be regarded as complete which1 fails to give due weight to such points as these, as well1 as to the evils and risks that attend any informal orr happy-go-lucky dealing with persons of unsound mind. The nature of these evils and risks are best understoodl by those who have made insanity and the insane their life-study and who are therefore most likely to act warilyr
In pointing out some of the difficulties that appear to us to stand in the way of the realisation of any such utopian scheme of legal "reform"" as Sir WILLIAM GoWERS has
unfolded,
.
we
importance
of
have not the
looking
slightest wish to minimise the the question of what can
into
be done to legitimise the domestic treatment of cases of mental unsoundness in its earlier or what may be and to anticipate them. These are the’evils and risks byr termed its pre-certificate stages, so that the necessity which all sorts of social and domestic questions arefor certification and transfer to an asylum may, if complicated, and which the law has been striving, during: possible, be averted. Steps in this direction were actively i some few years ago by a joint committee of the the past half century of official and general experience taken --
progress in the study of insanity, toMedico-Psychological and British Medical Associations and , In omitting to make specific to avert. the most experienced minds were able to make important reference to their existence Sir -WILLIAM GOWERS scarcelysuggestions and proposals for dealing with the treatment did his subject justice ; and his hosts, on his plea that he of ( incipient cases. These suggestions met with the was not of their body, may have felt themselves justifiedapproval of the legal authorities and if they bad been
and of
pathological provide against and
--
in speaking to the subject-matters of the address uponmade i the subject of legal enactment they were calcuwhich there was agreement and in not being adversely lated I to place this class of patient on at least as satiscritical upon such an occasion. f a factory footing in England as in Scotland. The Sir WILLIAM GowERS denies that the enforcement of theprimary question of the liberty of the subject teaches law in the cases of mental unsoundness with which he is dealing is either necessary for the safety of the public or in
circumspection in dealing with individuals ; and if medical r men persist in treating irresponsible persons in a manner the interests of the patient. "Taken altogether," he says, copposed to the sanction of official authority they do so "the danger is very small in comparison with the dangerwith v their eyes open. We are not prepared to say how longand harm the law produces, directly and indirectly." We are ssuffering the public or the law ought to be on such a matter not so clear on the point as is Sir WILLIAM GowERS. What or c to what extent medical men or others are to be allowed assurance can there be in a new case that the stability of the t interfere with personal freedom under the guise of duty, to harmless nature of the symptoms will continue from day to ssympathy, or kindness, except on lines which it is for the 1 to determine and to indicate. day ?? And how can we tell that the class of cases which he law considers now to be wrongly dealt with by law will remain a reasonably constant quantity and will not be extended into a more dangerous type ?? In any case, if the danger is very small this is no doubt largely due to the fact that the law has been, and is being, enforced. And can anyone doubt Ne quid nimis." that if its provisions were materially relaxed the return to c
Annotations. "
old-time scandals and abuses would sooner or later follow ?? The essential hardship to which Sir WILLIAM GOWERS is
K KING
EDWARD’S HOSPITAL FUND FOR LONDON.
A MEETING of the General Council of this Fund for the of awarding grants to the hospitals was held at purpose anxious to direct attention is ’’ that the law compels the " Y York House, St. James’s, on Nov. 24th, H.R.H. the Prince compulsory certification, however needless or harmful, as a of of Wales being in the chair. The report showed that the condition for the skilled care which can only be obtained sum St available for distribution had been increased through His notification and tl to it by His Majesty the King of his subjects’ the transfer remedy by by payment." proposed coronation gift. The committee was thus able to advise limited certification is not likely to be accepted as meeting cc the distribution for the year of £100,000, recommending that the official requirements of the case, for a certificate tb the money should be devoted towards (1) the opening of to the effect that Mr. X. "is a person of unsound closed beds ; (2) the wiping out of debt; (3) building improvemind and is not a proper person to be detained"" m ments ; and (4) general maintenance. The Prince of Wales involves a contradiction in terms in the majority moved m the adoption of the report in an excellent speech in of cases such as those to which Sir WILLIAM GOWERS which wl he referred feelingly to the benefactions of His Majesty refers : for in most of them the impossibility of any longer the King, Mr. Samuel Lewis, Lard Strathcona, Lord Mountthe Maharaja of Sindhia, the Maharaja of Jaipur, St managing the individual in his ordinary domestic sur- Stephen, an and while he expressed his pleasure in learning that others, roundings has been the very cause of his removal to the Metropolitan Hospital Sunday Fund had been in no way the care of a stranger. What about the civil status and in injured by the great prosperity of the King’s Fund. The responsibilities of a person thus certificated ?? At whose motion was seconded by the Lord Mayor and adopted, the instance and by what authority is this removal to be m( meeting terminating with a vote of thanks to the His Royal Hi for presiding, which was proposed by Lord Rothbrought about if he does not go voluntarily ?? How many Higness seconded schild, be had such a scl by Rev. J. Guinness Rogers, and carried could detained after they patients perused
elth
th
in-
document, and what different effect would that they are of unsound mind have circumstances as compared with the certification under existing conditions! theory and practice here will seldom
parallel
lines.
the statement
upon them in these effect produced by
un unanimously.
-
PRISONERS AND SUSPENSE. ,
THE somewhat unusual and confused proceedings that ’ We much fear that ha, have taken place before the Liverpool stipendiary magisbe found to run on trate tra in the case of the man charged with causing the del death of Mr. Kensit have no doubt had their origin to