THE LUNACY ACT, 1890.

MORTALITY OF ABSTAINERS AND MODERATE DRINKERS. to show that in most offices which draw a distinction between the lives of abstainers and those of moderate drinkers the claims are greatly less in the case of the

775

cantile Insurance Company has effected an arrangement with a committee representing the Civil Service, by which the company undertakes to grant policies to all who are members of the service, and effect inabstainers than in that of non-abstainers. In the Tem- applicants surances with the company during the next two years, perance and General Provident Institution the claims were making no inquiry as to the applicant’s present state of to the expected deaths only 70 per cent. ; in the general health, provided he is now in active service and had been section they were 99 per cent. In the Whittington Life subjected to medical examination for the purpose of his Office it was found that in three years the deaths in the admission to the service. Other concessions are made abstainers’ branch were at the low rate of 23 per 1000, relating to the amount and mode of payment of premiums and such-like matters, adjusted no doubt to the company’s while for the general section the death-rate was 50 per scheme of premium charges and to the requirements of the 000 for the same years. Dr. DRYSDALE also mentioned case. These it does not fall within our province to discuss, in his paper that three or four insurance oinces were keeping but the wholesale acceptance of risks without any sort of accounts in the Accident as between and medical even without business, examination, separate inquiry as to the total abstainers and others. The premiums are more facts of a proposer’s medical history, seems to us to be such reduced for abstainers, and the bonuses are larger. He also a departure from wholesome custom as cannot possibly be The company has bound itself to accept all risks quoted some statistics showing the less amount of sickness justified. that offer under these onerous conditions up to the limit of - experienced in Friendly Societies where the members are E1000 apiece, and it needs no great insight to foretell abstainers. Thus the Sons of Temperance have 7’48 that the offer will attract a great rush of undesirable weeks of sickness in equal times for each member, as proposers. An examination which took place ten, twenty, against 26’20 weeks of other groups of members of non- or thirty years ago, and in some cases still farther cannot afford any guarantee of present soundabstaining Friendly Societies. But these statistics are based back, and the test of active service, though evidence of a ness, on a comparatively small number of abstaining lives certain minimum of physical capability, is no evidence at all and are not very reliable. The discussion which followed of freedom from serious and even mortal disease. It is did not throw much light on the explanation of what hardly open, we think, to doubt that the company will be seems an enormous advantage on the side of teetotallers in found to have made a most improvident bargain, and we to of sickness. and the amount One hope that the directors, having been bold enough to make respect longevity remark by Dr. RICHARDSON is noticeable, though ques- this strange departure, will hereafter have the public spirit tionable. He entirely and absolutely denied that drinkers to publish for the information of the world at large the financial result of their experiment. take less food than teetotallers, and he based his opinion chiefly on his experience of the wealthy abstaining classes THE LUNACY ACT, 1890. of Ireland, obtained during a visit there. He argues that a household of teetotallers with teetotal servants expend WE have received a copy of a reprint of a paper on the 20 per cent. less on food than another household of the Lunacy Act, 1890, by Mr. C. T. Street. After stating that same style. He farther remarked that the element of the new Act is the outcome of a freely expressed discontent on the part of the public with the Lunacy Laws as worry in those who do not abstain was apt to lead insensibly existed, Mr. Street says he is inclined to think that the to unsuspected excess in the use of alcohol. One thing in they additional legislation enforced by this Act will be found all these statistics needs a little more certification-the rather to increase than diminsh the difficulties already exabsolute teetotalism of the alleged abstainers. The offices perienced by medical men in placing their patients under do not seem to us to have any satisfactory way of ascer- asylum treatment, and he cannot see that it will in any taining whether the so-called abstainers do abstain, and way benefit the patient either by making him more how far the moderate section are merely moderate. The contented with his lot or hastening his recovery. Instead of abolishing private asylums, which was the real lesson of the statistics probably is that a little excess, avowed object of the original Bill, the number of houses of which many people are guilty without suspecting it, where lunatics may be received for profit has been increased damages health considerably more than we have been apt to by allowing medical men to receive two or more insane think. This was the burden of Sir WILLIAM GuLi/s evidence patients into their own houses without even a licence, or the supervisory visitation required in the case of licensed before the Lords’ Committee, and it is unmistakably true. houses. Mr. Street goes on to say : "Every unfortunate person who now becomes ineane is to have an inquiry held upon him by a judge or magistrate, like a criminal, as if his disease were a crime, impressing on his mind, perhaps already perplexed by hallucinations and delusions of suspicion and doubt, or oppressed by gloomy despair and " Ne quid nimis." wretchedness, the idea that his liberty has been taken from him for some crime of which he knows nothing, or conLIFE ASSURANCE IN THE CIVIL SERVICE. firming his delusions of self-accusation or unpardonable MANY attempts have from time to time been made to sin for which he thinks he is now to be justly punished." popularise the practice of life assurance by including whole He strongly approves of the provision by which the groups or classes of persons in some comprehensive scheme; usual medical attendant shall, when practicable, be one and it has been remarked with much truth that an office of the certifying physicians. This, to his mind, is a which could effect policies on the lives of all the people who greater safeguard against improper confinement than in the course of a day pass by Charing-cross might be fairly all the magistrates’ orders put together. He regards well content with its selection of risks. The latest embodi- the judicial interference as the most objectionable measure ment of this idea does not, however, strike us as being a that has been passed both as regards the patient and his particularly happy one. The North British and Mer- friends. Referring to the use of the " Urgency Order,"

Annotations.

776 he thinks it will be found the most convenient and that the breathing remained good for fully forty-five seconds expedient method of admitting patient-’, as most recent after the pulse had ceased beating, and only then began to cases of insanity are urgent. One advantage of the Act fail. I may mention that the amount of chloroform used it consists in the protection gives to medical men gene- did not exceed one teaspoonful." of In persons of intemperate habits more or less fatty who certilicates insanity; and another is rally sign that it allows persons wishing to place themselves under changes are found in the organs, as in this case, and the heart sharing this morbid change is more prone to succumb care and treatment to enter private asylums as voluntary or to unwonted exertion. The prolongation of the period of order medical without certificate. Mr. boarders, any Street gives useful hints to medical practitioners in filling struggling, which slow chloroformisation renders inevitable, up certiticates, and generally goes over the clauses in the seems to be peculiarly unfavourable to fatty hearts by the New Lunacy Act which anect the interest of members of greater strain it causes. The muscles of the abdomen and, cliest walls become rigidly fixed, and so respiration and blood the profession in their dealings with the insane. circulation are hampered; and the heart, called upon to contract and dilate under increased pressure, fails to accomplish ILLUSTRATED JOURNALISM. the task, and fatal cardiac syncope ensues. The postWHILST fully admitting the skill and enterprise with mortem examination in the case mentioned above showed, which our young contemporary, the Daily Graphic, is en- moreover, that the ventricular wall was thinned, and so a. gaged in attempting to furnish a pictorial record of current further disabling factor was at work. The publication oif affairs, and giving the management full credit for their such cases is of great value ; indeed only by this means can endeavour to arouse an interest in the work of our great we hope to accumulate trustworthy clinical knowledge metropolitan charities by illustrations of hospitals and their the action of chloroform. inmates, we feel constrained to point out that such representations may, if care be not exercised in the selection of THE PAVY GYMNASIUM, GUY’S HOSPITAL. "subjects," tend to defeat their purpose. This caution is, AN interesting ceremony took place on Wednesday, we think, justified by the publication of a sketch in the Oct. Stb, at Guy’s Hospital, when Dr. Pavy formally handed issue of that journal for Oct. 6th, to which a correspondent over to the Gymnasium Committee of the Student’s Club has drawn our attention. The artist has depicted what the gymnasium which he has built and furnished for theiy purports to be a scene in the "surgeon’s room " of a well- recreation. Mr. Arthur Durham, the President of the known hospital, and our correspondent remarks that "if Student’s Club, took the chair at the meeting which patients see that the privacy of hospitals is liable to be in- was held in the gymnasium, and there were vaded " in such a manner, "they will not resort to hospitals present the Treasurer of the Hospital, Mr. Shaw except in cases of the last necessity." We confess that there Stewart, many members of the hcspital staff, and a, is some reason in his remark, and could at least have hoped number of students. Dr. Pavy, who was received that the artist had selected some other subject for the dis- large with great enthusiasm, pointed out the physiological play of his talent. To be sure, he might quote the example reasons which had led him on his retirement from the of not a few pictures in the Paris Salon (notably one now to staff of the hospital to choose a gymnasium as a be found in the Salpctriere Hospital) in justification of his acting to the present and future students, and expressed a gift selection ; but the taste for such realistic reproductions of fervent wish that it be a means of promoting their the out-patient room has happily not hitherto been culti- health and success. might Mr. Bligh, the secretary of the vated on this side of the Channel. gymnasium, in heartily thanking Dr. Pavy for his generous gift, made an interesting statement as to arrangements that have been made for instruction and class practice in gym. DEATH UNDER CHLOROFORM AT BRISBANE. nastics. The meeting broke up with three cheers for DR. WM. S. BYRNE, hon. physician to the Brisbane Dr. Pavy. The gymnasium, which is situated in the General Hospital, has favoured us with the following account quadrangle of the New College, is fitted with all the most of death during the administration of chloroform :and about modern appliances, and is adjacent to the bath-rooms and a man of "N. ___

.

M——,

intemperate habits,

forty years of age, was given chloroform on August 12th for the purpose of having several fistulæ in the perineum opened up. Dr. Love administered the anaesthetic, and I was about to operate. The patient was prepared in the usual way, a brisk purge having been given the night before, and no food being allowed for six or seven hours prior to the operation. About thirty drops were sprinkled on a flannel, and for about ninety seconds everything seemed to be mosb satisfactory, but shortly after some more chloroform had been dropped on the flannel the patient became very excited and the face suffused. Immediately after his pulse became very weak, and I called Dr. Love’s attention to it, but then it had stopped altogether, although the breathing was quite as good as one could wish. The chloroform was at once removed, and we waited the development of events, trusting the pulse would improve as the man was breathing so well; but aftcr the space of fully forty.five seconds his breathing began to fail, and artificial respiration and all the usual remedies were used for a long time, but without avail. I was present at the post-mortem examination, which disclosed lungs infiltrated with tubercle, a heart healthy as to the valves, but walls of right ventricle rather thin, and a liver slightly fatty. This case is interesting from the fact

lav atories. ____

THE CASE OF PAUPER LUNATICS.

magistrates have incurred a just rebuke at a coroner’s jury of that city for having strangely neglected to take proper precautions for the safe custody of a pauper lunatic who recently committed suicide in the Fishponds Workhouse. The pauper had on more than one previous occasion manifested a suicidal tendency, and had been certified as insane by the medical officer off the workhouse. The medical officer’s certificate was duly submitted to the magistrates, who, however, formed an opinion of their own, and refused to make the THE Bristol the hands of

necessary order for the detention of the unfortunate as a lunatic. The consequence was that she was left to take her place among the other inmates of the institution, and easily found an opportunity of committing the suicide on which she was bent. In view of what has occurred, it cannot now be contended that the magistrates were not wrong, or that the medical officer was not right; and in this state of facts it is worthy of note how serious an infraction of the law in its spirit, if not in its letter, the mistake of the magistrates involved. The Act of last year expressly provides that no person shall be woman