The Lunacy Commission.

THE

1208

LUNAOY COMMISSION. be

punished and not as a patient to profession has consistently striven tion, and thanks of

THE LANCET. LONDON: SATURDAY, OCTOBER 28, 1911.

public opinion

be treated.

The medical

to combat this bad tradi-

to its strenuous efforts the whole

and

legislative

PINEL has been in the direction of

tendency days of

action from the

to the insane accords to the enlightened humanity privileges sufferers from more patently physical diseases. And if this change of attitude has immeasurably alleviated the lot of these unfortunate invalids, it has had an indirect influenceof even greater ultimate importance in stimulating that

which

the

extending

an

study of insanity by which, and by which alone, we may hope to discover, and hence to counteract, thecauses of a malady that constitutes at once a heavy burden on the community and a danger to its vitality. The.recognition of this truth that insanity is a disease inspires the whole system of asylum treatment which it is the special function of the Commissioners in Lunacy to supervise; the statutory duties imposed on the Commissioners by the Lunacy Acts are chiefly concerned with medical questions the annual reports in which they render an account to the public of their performance of these duties deal mainly with, matters of strictly medical science, with the discussion of problems of etiology, with the investigation of zymotic diseases specially prevalent amongst the inmates of asylums and with kindred topics. It is hard to imagine in what manner the discharge of these functions could be promoted by an addition to. the already large legal element on the Bosrd, but it is. not at all hard to conceive that such a deplorable step must react injuriously on the scientific position of English psychiatry, and might tend to revive in the public mind theunfortunate errors and prejudices which formerly prevailedscientific

The

Lunacy

Commission.

FOR several years past it has been generally recognised that the enormous increase in the work devolving on the Commissioners in Lunacy has made it imperative that their number should be augmented by the appointment of additional medical members. Since the passing of Lord ASHLEY’S Act, which established the Board of Commissioners on its

present basis in 1845, the number of persons officially recognised

as

fold, and

insane in

England

and Wales has increased four-

reaches the formidable

figure of 130,000, but responsible for the of this of the insane and for the inspection host supervision of the establishments in which they are housed is still It is no reflection on the distinguished limited to three. physicians who have held these offices to say that the work imposed upon them under these conditions has been beyond their powers. So intolerable, indeed, has the position now

the number of medical Commissioners

become within the last few years that it has been necessary an immediate remedy without waiting for that entire

to find

recasting of the machinery tally defective which we

for the

supervision of the menpromised since the publication of the report of the Royal Commission on the Cjje and Control of the Feeble-Minded. Legislation has accordingly been initiated, and the Lunacy Bill which was before Parliament this year provides for the appointment of two additional Commissioners. It does not, however, expressly require that they should be medical men, and we understand that in certain quarters efforts are being made to secure that one of them shall be a legal representative, thus giving four lawyers and four medical men as paid members have been

of the Board. It is hardly conceivable that the authorities in whose hands these appointments rest should entertain so extraordinary and reactionary a proposal, but the very fact that it should have been put forward at all makes it desirable

medical

With the addition of two on the-

Commissioners, the medical representation

Board will still be

quite inadequate, as may be seen by corn. will not say with continental countries, but even with Scotland and Ireland. In Scotland, where the insane parison,

we

some 20,000, there are two senior and two junior medical Commissioners in Lunacy, and in Ireland the supervision of the 25,000 lunatics is entrusted to two>

number

inspectors. It can hardly be suggested that there is any extravagance in the arrangement by which in this country five medical men are expected to dismedical

functions for 130,000 patients. And in this connexion we may remark that the anomalous position of England with regard to the medical supervision of the

charge

the

same

expressed very explicitly on insane is of comparatively recent origin ; the Metropolitan the matter. It is not a question of securing positions of Commissioners, who, prior to Lord AsHLEY’s Act, exercised patronage for the members of a particular profession ; if it the powers vested by that Act in the Commissioners in were merely that, the general public at all events might be Lunacy, included five physicians originally, and by subse., content to take a detached view of the issue, satisfied from quent legislation the number was raised to seven ; and at a past experience that the claims of the legal profession are still earlier period, under GEORGE III., no less than five not likely to be under-stated. The question goes much physicians were deemed necessary for the inspection of it not welfare of a very large the insane in the metropolis of that day. concerns the Some of deeper : only number of sick persons, but also affects the consideration of our contemporary politicians do lip-service to the ideas a bio-social problem which is of vital importance to the and the spirit of modern science: they have now an The demand for further community. legal representation opportunity of showing whether in their appreciation of the fact that insanity is a disease they are at least as on the Lunacy Commission is in effect the reaffirming of the tradition which separates insanity from disease and enlightened as were their predecessors of the Georgian regards the lunatic somewhat in the light of a wrong-doer to era. that medical

opinion

should be

with reference to the insane.