The Illegal Detention of Lunatics.

312 from another animal, springs from the actual cells introduced and not from the part into which the portion of Dr. BASHFORD and Dr. MURRAY tumour was implanted. conclude from their researches thatcancer is an irregular and localised manifestation of a process otherwise natural to the life-cycle of all organisms." We may be sure that the work of Dr. BASHFORD and Dr. MURRAY will receive the closest attention from all pathologists and biologists, for the significance of such a conclusion, as dictating the direction of future research work, is immense. The public, who have read extracts in the daily press from the two papers under consideration, have imagined that we are now measurably nearer a knowledge of the etiology and treatment of malignant disease. Unfortunately this is not so. A direction, apparently of a most valuable kind, for future investigation has been provided. As to the importance of the observations there can be no question, but the conclusions that we may safely draw from the excellent work that has been done would seem to the lay mind rather meagre. Let us review what fresh data we have obtained. We have learnt, first, that the mode of nuclear division observed in most of the dividing cells of malignant growths resembles very closely, or is even identical with, that seen in the reproductive tissues and differs greatly from the mode of division in ordinary somatic cells ; secondly, that this form of mitosis is found not only in malignant new growths occurring in human beings but also in all the malignant growths examined which occurred in lower vertebrates of many species. What conclusions To say that because may be drawn from these data ? the mitotic changes in cancer resemble very closely the mitotic changes in reproductive tissue therefore there is necessarily an identity in the physiological processes of these two tissues is a faulty syllogism ; for as we know nothing of the true meaning of the nuclear changes in

utterly unable to predicate anything as interpretation of the nuclear changes in malignant growths. Therefore any theory of etiology depending on this cell division

we are

to the

And if we resemblance rests on a very frail support. cannot see at present how these recent observations can serve to elucidate the difficult problem of cancer genesis so we are equally unable to draw any very hopeful inferences as to a treatment of cancer which may serve to control this

widespread

scourge.

Nevertheless, every new fact, every aspect of facts already known helps

idea, every new forward the day when we shall understand fully the etiology and treatment, both preventive and curative, of malignant disease. We congratulate Dr. BASHFORD heartily on the issue from the central laboratory of the Cancer Research Fund of so important an addition to our exact knowledge. He has furnished the governing body, among whom may be found the name of His Majesty the KING, with an admirable argument wherewith to charm money from the new

public pocket. i

The

Illegal

Detention of Lunatics.

A MAN named AVARD was convicted under the Lunacy Act, 1890, at Bearsted in Kent on Jan. 18th and fined f:15 with L10 costs for receiving lunatics in an un-

licensed house. He had apparently done this for some as one of the inmates of this establishment, of

time,

whom there were seven, had been there since 1888. Dr. F. P. DAYIES, medical superintendent of the Kent County Asylum, who, instructed by the Lord Chancellor, had visited AVARD’S premises, informed the magistrates that he found the bedding used by some of the inmates in an indescribably filthy condition, that there was no provision for safety in the case of fire, that there were only two attendants of any kind, and that he could not ascertain that any medical man had attended any In the circumstances the of the persons received. penalty imposed may be regarded as a light one but the magistrates were evidently impressed with the length of time during which this very undesirable institution had existed without attracting attention. No doubt the Commissioners in Lunacy acted as soon as they were informed, but is certainly a matter for surprise that no one should have thought it desirable to interfere sooner. The nature of the house and the outline of the provisions of the lunacy law are matters of which, it might be thought, the local police would have some cognisance and in which members of the public might also reasonably be expected to take an interest. Instances of the detention of the insane in unlicensed houses under the care of persons, not only unprovided with any legal title to practise medicine but not even conversant with nursing, are brought to light from time to time. Sometimes the persons so detained are found to have been treated with every care and those charged with detaining them have disputed their guilt on the ground that the mental condition of the patients was not such as to require certification. Two instances of this occurred in the metropolitan district in September, 1901, and in September, 1902, respectively, but in both of these cases the magistrates did not accept ignorance of the fact that a breach of the law was being committed as an excuse and fines were imposed larger than that inflicted upon AVARD. Cases such as these present features which show the need for public supervision and inspection whenever the mentally weak have to be provided for. In most instances the person charged is usually found to have had no medical training and no experience in the tending of the feeble minded. Unfortunate persons, harmless but imbecile, frequently suffering from senile dementia accompanied perhaps by chronic palsy of the limbs, become a burden to their relatives who desire to get rid of the charge of them and at the same time to secure their object with the minimum of expense and publicity. The poor creatures thus afflicted are consequently handed over to someone who is recommended to the relatives by a carefully worded advertisement and afterwards, so long as the small

it

payment agreed upon is maintained,

can be conveniently who takes an interest in the forgotten. When someone, welfare of his fellow creatures apart from any personal acquaintance which he may have with them, chances to

call the attention of the Commissioners in Lunacy to what is going on it is found that the insane persons have been maintained alive, for that is necessary in order that their keepers may derive an income from them, but that beyond this they have been allowed to live in a state of filth, misery, and neglect, constituting cruelty of the grossest kind. At the house of AVARD it will be noticed there were no against fire, and no doubt had a fire taken place a holocaust would have been the result with the probable

precautions

313 consequence of an indictment for manslaughter againstisurgeons as in order to provide that nothing should 1 lost which it was possible for them to supply. It AVARD himself. It is not often, no doubt, that institutions be so large as his go on for so long unobserved, but at the same has been long conspicuous as one of the chief centres time large premises give the idea that a home for the infirmof cranial and spinal surgery in the metropolis and is being maintained and thus act to some extent as a pro-a pathologist occupies an important position among its tection to the unlicensed masters of such establishments. officers. With these advantages, it can be no matter for The Commissioners in Lunacy must depend for their surprise that it has been much frequented by visitors from

information upon the goodwill of the public, and members of the public, including medical men, who are not unlikely to be acquainted with the reputation of houses in their neighbourhood, no doubt do a good work in calling the Commissioners’ attention to the desirability of inquiry where the treatment of persons helpless on their own behalf is concerned. The Commissioners do not themselves visit the unlicensed house, but the Lord Chancellor or the Home Secretary has power to make an order requiring a specified person or persons to visit a place where alleged lunatics are detained and to make a report. It was in pursuance of such an order that Dr. DAVIES visited the premises of AVARD in the case under discussion, with the result that the inmates are now, it is to be hoped, in institutions where proper care will be taken of them. Where

the continent and from America, or that its out-patient rooms have often been so thronged by post-graduate students as to remind those frequenting them that, just as shoe-

makers’ wives are said to be the worst shod, so the conditions of atmosphere tolerated by medical audiences are often such as could not be conscientiously approved in places of even temporary sojourn for their patients. Nor is it the least among the merits of the institution as now existing that it was lately the arena of a conflict between

lay committee and the medical staff who were determined to recover a position of influence in its management of which they had been gradually and quietly deprived. We need not dwell upon the details of a dispute which will be fresh in the recollection of our readers and it is enough to say that the staff, after enduring all thirgs at two or three persons only are detained illegally, or only the hands of the committee and of its executive officer, one, observation is less likely to be excited, but the law were at last completely successful in an appeal to the general provides a remedy and the Commissioners in Lunacy are body of the governors. The committee was reconstituted ready to enforce it wherever evidence is obtainable upon with members of the staff forming an integral part of it and which they can act. with the complete abolition of the sway previously exercised by a non-medical official. the

hospital with these antecedents and abundantly supplied description would be untrue to its traditions if any slackness concerning research were displayed by the members of its staff, and hence it is not surprising that the pages of Brain, the oflicial journal of the Neurological Society, have been THE appeal in aid of a research fund, which has just been largely occupied with accounts of the work done within issued by the authorities of the National Hospital for the its walls. To one portion of this work the appeal before us Paralysed and Epileptic in Queen-square, is one that deserves might properly call attention-namely, to the paper on the earnest consideration of all who are in a position to Landry’s Paralysis contributed by Dr. E. FARQUHAR BUZZARD promote the attainment of the end desired. The hospital to the spring number, and containing an account of a microin question from its very foundation has occupied a unique coccus which he obtained from a patient dying from the position as one in which the advancement of science disease in the hospital and from cultures of which he prohas been recognised as a primary object of its existence. duced an analogous form of paralysis in a rabbit. We Originally founded by two ladies, who had witnessed the possibly do not exaggerate in assigning to this discovery a prolonged sufferings from paralysis of a beloved relative place equal in importance to that of the discovery of the tryand who desired to prevent the occurrence of similar panosoma of sleeping sickness, for the former disease was suffering in others, the hospital received the stamp previously quite as mysterious as the latter and, although not of its future character from the first appointments made frequent, it has of late years been increasingly observed both to its medical staff, appointments which included the in this country and in America. One of the earliest cases A

The National Hospital for the Paralysed and Epileptic and Organised Scientific Research.

with clinical material of the most varied

recorded in London was communicated to the Clinical Society in 1875 by the late Dr. ANSTiE who attended it in conjunction with the late Sir ANDREW CLARK and who, like him, was not only quite unprepared for the rapidly fatal issue but did not at first recognise that he was dealing with a condition involving danger. Dr. ANSTIE’S paper opened ground so completely new that it elicited no other remark than an expression of sympathy with the father of the patient who was himself a member of the society. inquiry. Ophthalmic surgeons, an aural surgeon, a laryn- No one had a word of suggestion either as to the actual gologist, were from time to time added to the staff, not condition or the possibilities of treatment. In contrast so much because the departments thus represented would with this Dr. BUZZARD is able to draw upon a chronicle otherwise have been neglected by the physicians and of several recently recorded cases, and although he

of BROWN-SÉQUARD, of LOCKHART CLARKE, and of CHARLES BLAND RADCLIFFE. Besides affording material for their investigations it was the first hospital in London, or probably in Great Britain, to possess the means for adequately conducting and testing various forms of electrical treatment, and it has always been conspicuous for its promptitude in recognising and in rendering available every ray of light which could be thrown upon its proper work by those engaged in other departments of medical

names