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MEDICAL CONTRACT WORK IN THE COUNTY OF DURHAM.
618 There are no doubt other causes of temporary insanity, causes more obscure and less definite in prognosis, but they are not so difficult to discover by those experienced in these maladies as to require the formidable and comtreatment.
Correspondence. "Audi alteram
plicated legal procedure English public.
partem."
MEDICAL CONTRACT WORK IN THE COUNTY OF DURHAM. To the Editors of THE LANCET. SIRS,-In the county of Durham we are in the midst of
a
JEPSON,
President of the Durham Medical Union. Durham, Feb. 27th, 1899. Our * correspondent will find that we have on more than one occasion urged upon the profession the necessity of supporting one another in this movement and similar movements. We trust that no medical man will be so blind to the interests of the profession which he has joined (and therefore in the long run to his own interests) as to accept lower terms from the miners of Durham than those which the present members of the Durham Medical Union are justly asking.-ED. L.
YERSIN’S PLAGUE SERUM. To the Editors of THE LANCET. THE LANCET of Jan. 21st your special SiRs,-In in India states in connexion with my correspondent evidence before the Indian Plague Commission that I"had nothing conclusive to say from personal experience " as to the value of Yersin’s serum. Will you allow me to state that, the contrary, I was able from personal experience to give a very definite opinion as to the value of this form of treatThat conclusion was, I regret to say, ment in plague ? unfavourable to the claims of the serum. It was based upon a carefully conducted trial in which 50 cases of plague were submitted to the serum treatment and 50 other cases in the wards at the same time were noted as control cases. As the mortality in each group of cases was the same (80 per cent.) and as there was no perceptible effect whatever upon any of the symptoms I was forced to the conclusion that Yersin’s serum is an entirely indifferent substance in the treatment of plague without influence for good or evil upon the course of the disease. I hope shortly to publish notes of the cases. I am, Sirs, yours faithfully, FRANK G. CLEMOW. Calcutta, Fe].. 9th, 1899.
imposed
on
the
The question at issue is whether every person who is insanefrom the medical standpoint should be swept into the asylums of the country or be placed under medical certificates such as at present are in use. Is he "a proper person to be detained under care and treatment and in a fit condition of bodily health to be removed to an asylum"? These are the words of the schedule. The answer must be emphatically " No." It is well known to those directly interested in the treatment of the insane that efforts are being made to avoid the manifest evils of the present system, by introducing into the English law a provision which has long existed in Scotland, whereby those afflicted by temporary insanity can be placed under suitable private care upon the certificate of the medical attendant to the effect that the malady is not confirmed and that such treatment is necessary for a period not exceeding six months. This should have the hearty support of the medical profession in the interests of the insane. Mr. Sers entirely misses the central point of the case in suggesting that Dr. Reichardt assumed a responsibility which he was not called upon to assume. On the contrary, he fortified himself behind the authoritative opinions of Dr. Savage, Dr. Goodhart, and Mr. Kingsford. No evidence in the opposite sense, of similar weight, was adduced by the Commissioners who of course acted on the law as it stands. We may assume that they are well aware of the unsatisfactory results of the present Act which threaten to become worse in time unless remedies are applied. Yet such are the operations of the law that Dr. Reichardt after technically winning his case finds himself most severelv fined. Surely there is something much amiss leading to such a fiasco. One calls to mind Mr. Anderson’s hard lot when the jury awarded him heavy damages and the Chief Justice of England immedi. ately informed him that he was not permitted to give effect to their verdict. I urge that the medical profession should fully recognise that not every case of insanity should be sent to an asylum, that the limitations of the present law are prejudicial to the insane and to those who are bound to serve them, and that relief must be sought from the present impasse.
struggle to obtain a higher rate of pay from the miners of the collieries; in some parts we have succeeded beyond expectation, some are wavering, and some are in direct opposition to the change. With patience and gentle forbearance we shall get all to agree to the increase. Our present danger is from those of our own profession who may step in and accept the old terms. I ask for your powerful aid in preventing any such occurrence. Members of the Medical Union are working shoulder to shoulder and will stoutly resist the invasion of strangers, and those of our number who may suffer loss from temporary suspension of pay will be assisted by their more fortunate brethren. I am, Sirs, yours faithfully, T’BT:{1’ T"I1’TBc(I’B"’-T "TIT"B EDWARD
which has been
AN ASYLUM PHYSICIAN. 13th, 1899. P.S.-Since the foregoing letter was written the Lord Chancellor has indicated a favourable opinion regarding the principle of the proposed clause in reference to incipient. insanity, on the representations made by a joint committee of the British Medical and Medico-Psychological Associations on Feb. 22nd. Feb.
on
I
INTRAVENOUS INJECTIONS IN SYPHILIS. To the Editors of THE LANCET. SIRS,-I was much interested to see the results of intravenous
lished
injections
of
cyanide
of mercury in
syphilis pub-
by [Mr. Chopping in THE LANCET of Feb. 18th. It, however, does not appear to me that these results maintain, the
"REGINA
v.
REICHARDT."
advantages claimed for this method of treatment. The advantages claimed are : (1) as the injection is made daily
the patient is under constant observation ; (2) the exact To the Editors of THE LANCET. quantity of mercury introduced into the system is known ; SIRS,-If Mr. Sers will turn to the Lunacy Acts he will see (3) the patient is brought more rapidly under the influence of that a lunatic is defined as an idiot or a person of unsound mercury than by other methods ; (4) serious lesions clear up mind, and that medical certificates of insanity must state more rapidly; and (5) this treatment is useful where other that the person affected is a lunatic, an idiot, or a person of methods fail. The last of these claims is the only one unsound mind. The Scottish Acts, however, permit in addi- apparently above criticism. With regard to the others:o tion the use of the term "an insane person." There is (1) daily injection is irksome and inconvenient both to the therefore no need to differentiate between the phrases patient and the operator and requires many more injections " ’’ temporary unsoundness of mind" and ’’ temporary than are given in the intra-muscular method ; (2) the"exact insanity." It is of no importance from a legal point of view. quantity of mercury introduced into the system " is not the Delirium tremens and the delirium of typhoid fever are both point in question, which is rather the effect produced on the manifestations of temporary insanity and persons of unsound patient by mercury under any method of administration, mind owing to these toxagmic disorders have occasionally been and this can only be judged by its effects, not by certified to be insane. That is not of frequent occurrence, any method of measuring quantities; and (4) as to grave for the medical profession is educated to foresee that the lesions clearing up more quickly under this treatment, mental trouble is temporary and consequent on a physical state this might be claimed for other methods, for those who have which can be corrected without resort to asylum care and dealt much with syphilis know that similar lesions in
Correspondence. "Audi alteram
plicated legal procedure English public.
partem."
MEDICAL CONTRACT WORK IN THE COUNTY OF DURHAM. To the Editors of THE LANCET. SIRS,-In the county of Durham we are in the midst of
a
JEPSON,
President of the Durham Medical Union. Durham, Feb. 27th, 1899. Our * correspondent will find that we have on more than one occasion urged upon the profession the necessity of supporting one another in this movement and similar movements. We trust that no medical man will be so blind to the interests of the profession which he has joined (and therefore in the long run to his own interests) as to accept lower terms from the miners of Durham than those which the present members of the Durham Medical Union are justly asking.-ED. L.
YERSIN’S PLAGUE SERUM. To the Editors of THE LANCET. THE LANCET of Jan. 21st your special SiRs,-In in India states in connexion with my correspondent evidence before the Indian Plague Commission that I"had nothing conclusive to say from personal experience " as to the value of Yersin’s serum. Will you allow me to state that, the contrary, I was able from personal experience to give a very definite opinion as to the value of this form of treatThat conclusion was, I regret to say, ment in plague ? unfavourable to the claims of the serum. It was based upon a carefully conducted trial in which 50 cases of plague were submitted to the serum treatment and 50 other cases in the wards at the same time were noted as control cases. As the mortality in each group of cases was the same (80 per cent.) and as there was no perceptible effect whatever upon any of the symptoms I was forced to the conclusion that Yersin’s serum is an entirely indifferent substance in the treatment of plague without influence for good or evil upon the course of the disease. I hope shortly to publish notes of the cases. I am, Sirs, yours faithfully, FRANK G. CLEMOW. Calcutta, Fe].. 9th, 1899.
imposed
on
the
The question at issue is whether every person who is insanefrom the medical standpoint should be swept into the asylums of the country or be placed under medical certificates such as at present are in use. Is he "a proper person to be detained under care and treatment and in a fit condition of bodily health to be removed to an asylum"? These are the words of the schedule. The answer must be emphatically " No." It is well known to those directly interested in the treatment of the insane that efforts are being made to avoid the manifest evils of the present system, by introducing into the English law a provision which has long existed in Scotland, whereby those afflicted by temporary insanity can be placed under suitable private care upon the certificate of the medical attendant to the effect that the malady is not confirmed and that such treatment is necessary for a period not exceeding six months. This should have the hearty support of the medical profession in the interests of the insane. Mr. Sers entirely misses the central point of the case in suggesting that Dr. Reichardt assumed a responsibility which he was not called upon to assume. On the contrary, he fortified himself behind the authoritative opinions of Dr. Savage, Dr. Goodhart, and Mr. Kingsford. No evidence in the opposite sense, of similar weight, was adduced by the Commissioners who of course acted on the law as it stands. We may assume that they are well aware of the unsatisfactory results of the present Act which threaten to become worse in time unless remedies are applied. Yet such are the operations of the law that Dr. Reichardt after technically winning his case finds himself most severelv fined. Surely there is something much amiss leading to such a fiasco. One calls to mind Mr. Anderson’s hard lot when the jury awarded him heavy damages and the Chief Justice of England immedi. ately informed him that he was not permitted to give effect to their verdict. I urge that the medical profession should fully recognise that not every case of insanity should be sent to an asylum, that the limitations of the present law are prejudicial to the insane and to those who are bound to serve them, and that relief must be sought from the present impasse.
struggle to obtain a higher rate of pay from the miners of the collieries; in some parts we have succeeded beyond expectation, some are wavering, and some are in direct opposition to the change. With patience and gentle forbearance we shall get all to agree to the increase. Our present danger is from those of our own profession who may step in and accept the old terms. I ask for your powerful aid in preventing any such occurrence. Members of the Medical Union are working shoulder to shoulder and will stoutly resist the invasion of strangers, and those of our number who may suffer loss from temporary suspension of pay will be assisted by their more fortunate brethren. I am, Sirs, yours faithfully, T’BT:{1’ T"I1’TBc(I’B"’-T "TIT"B EDWARD
which has been
AN ASYLUM PHYSICIAN. 13th, 1899. P.S.-Since the foregoing letter was written the Lord Chancellor has indicated a favourable opinion regarding the principle of the proposed clause in reference to incipient. insanity, on the representations made by a joint committee of the British Medical and Medico-Psychological Associations on Feb. 22nd. Feb.
on
I
INTRAVENOUS INJECTIONS IN SYPHILIS. To the Editors of THE LANCET. SIRS,-I was much interested to see the results of intravenous
lished
injections
of
cyanide
of mercury in
syphilis pub-
by [Mr. Chopping in THE LANCET of Feb. 18th. It, however, does not appear to me that these results maintain, the
"REGINA
v.
REICHARDT."
advantages claimed for this method of treatment. The advantages claimed are : (1) as the injection is made daily
the patient is under constant observation ; (2) the exact To the Editors of THE LANCET. quantity of mercury introduced into the system is known ; SIRS,-If Mr. Sers will turn to the Lunacy Acts he will see (3) the patient is brought more rapidly under the influence of that a lunatic is defined as an idiot or a person of unsound mercury than by other methods ; (4) serious lesions clear up mind, and that medical certificates of insanity must state more rapidly; and (5) this treatment is useful where other that the person affected is a lunatic, an idiot, or a person of methods fail. The last of these claims is the only one unsound mind. The Scottish Acts, however, permit in addi- apparently above criticism. With regard to the others:o tion the use of the term "an insane person." There is (1) daily injection is irksome and inconvenient both to the therefore no need to differentiate between the phrases patient and the operator and requires many more injections " ’’ temporary unsoundness of mind" and ’’ temporary than are given in the intra-muscular method ; (2) the"exact insanity." It is of no importance from a legal point of view. quantity of mercury introduced into the system " is not the Delirium tremens and the delirium of typhoid fever are both point in question, which is rather the effect produced on the manifestations of temporary insanity and persons of unsound patient by mercury under any method of administration, mind owing to these toxagmic disorders have occasionally been and this can only be judged by its effects, not by certified to be insane. That is not of frequent occurrence, any method of measuring quantities; and (4) as to grave for the medical profession is educated to foresee that the lesions clearing up more quickly under this treatment, mental trouble is temporary and consequent on a physical state this might be claimed for other methods, for those who have which can be corrected without resort to asylum care and dealt much with syphilis know that similar lesions in