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must be viewed by the light of this fact. The Catholic bishop of Clifton added his entreaties to those of Miss Knight's relatives for her removal to Bristol: a circumstance leaving no doubt that Miss Jerningham's opposition was actuated not so much by religious scruples as by indignation at her "outraged homoopathy."

Miss Knight was eventually removed, but after so protracted a delay, that she subsequently lived only three weeks.

Is it not reasonable to suppose, that if this unhappy lady had met with proper treatment at the earlier stage of her disease, her mind might have been restored and her life preserved ?

976 of them belonged to Paris, 182 to the department of the Seine, the rest to different parts of France, and 61 to foreign countries. Amongst the foreigners were 1 Englishman, 21 Belgians, 16 Sardinians, 6 Prussians, and 5 Germans. The number of persons discharged in the course of the year was 849; of cured, 556; and of deaths, 462. The proportion of deaths was nearly half less than in the ordinary hospitals; and the principal cause of them was paralysis, that disease having caused 194 of the total. All the lunatics of Paris and the department are not treated in the asylums of Paris; some are maintained in those of the provinces-Blois, Maréville (Muerthe), Armentières (Nord), etc.-but at the expense of Paris. The expense of each lunatic Finally, let me ask, what would be the power of the per day in Paris was 1f. 50c. for men, and 1f. 20 c. Commissioners in Lunacy in a similar case? By the for women; and in the provinces it averaged from eighth section of the Act for the Regulation of the Care 1f. to 1f. 25 c. The total expense of the year was and Treatment of Lunatics, no single patient can be 1,438,432 f. 78 c.; of which 464,065 f. were disbursed taken charge of in a private house without proper cer- in the asylum of Bicêtre, 592,542 f. in that of La Sal tificates sent to the Commissioners, and without official pétrière, and the rest in the provinces. Part of the visitation. Would this enactment affect an insane expense, however, has to be repaid by the families of patient in a convent, or would the character of the the patients, the prefecture of police, and the rural house interpose a bar between the Commissioners and communes; and another part by foreign governments their duties? If so, would the same occur in the amongst which governments that of England owes instance of any other religious community, an An-711f. 30 c.; that of Belgium, 6344f. 50 c.; and that glican sisterhood, for example, or an Agapemone? of Piedmont, 2867 f. 80 c. By a law of 1838, two sorts Should this be the case, and should any person wish to establish a perfectly close uninspected asylum for ladies, it will only be necessary to give it the character of a religious community, and to defy the law and the Commissioners.

In the present instance the patient was insane six years before her relations knew it, and was treated homoeopathically; she appears in other respects to have received personal kindness and humane attention at the hands of her superior. Is it impossible that in other places both the globules and the humanity may be omitted, and the old system of treating the insane in convents and monasteries described by Esquirol should be resorted to?

I am, Sir, your obedient servant,

London, March 3rd, 1854.

M. D.

of admissions into lunatic asylums are allowed: one, called "voluntary," is that of non-dangerous lunatics on the demand of their families; the second, called "official," is ordered by the prefecture of police, with respect to persons whose maladies are dangerous to themselves or others. Before 1838 the number of official admissions was less than that of voluntary admissions; from 1833 to 1838, for example, the former was 2821, and the latter 4242. But from 1838 to 1851, out of 16,716 admissions, 4163 were voluntary and 12,553 official. Of the 1509 admissions of 1852, 398 were voluntary and 1111 official. Up to the commencement of the nineteenth century, the laws did not occupy themselves with the condition of lunatics. Confounded with thieves and vagabonds, lunatics were confined in the prisons and hospitals. From a report presented in 1791 to the National Assembly by M. de La Rochefoucald-Liancourt, it appears that at that time the number of lunatics was 1331. At that period two wards of the Hôtel-Dieu were reserved to the A report on the situation of lunatics in the asylums curable; but they were often placed three or four of Paris was presented to the council general of the together, men and women in the same bed; the more Seine in its last session. On the 31st December, 1852, violent were even bound with chains, and the other the number of lunatics under treatment was 3182. In patients heard all day long their cries, or witnessed all France there were 16,719, which made one in every painful scenes. The incurables were placed at Bicêtre, 2123 of the total population; but in Paris and the La Salpétrière, and the Petites-Maisons (at present department of the Seine the proportion was one in Hospice des Ménages). The cells in which they were every 474. This was owing to the fact, that at Paris confined were only six feet square; light and air were idiots are readily admitted into asylums, in order to admitted by the door; truckle beds, covered with prevent them from becoming a spectacle or being ill- straw and fastened to the walls, were all they had to treated in the streets; whereas, in the country, great sleep on; and water fell from the walls. In 1792, numbers not being dangerous are allowed to be at Dr. Pinel, physician of Bicêtre, and afterwards of large, and are generally treated kindly by everybody. La Salpêtrière, put an end to this frightful state of In 51 years the number of lunatics in Paris and the things. The creation of the Conseil General des department of the Seine has increased from 946 to Hospices in 1800 completed his undertaking. Since 3182. The number of admissions in the course of that time vast improvements have been introduced 1852 was 1509. Amongst them were 454 traders, 149 into the treatment of the insane. Spacious and healthy members of liberal professions, 26 agriculturists, etc.; | lodgings with boarded floors have been substituted for

Statistics of the Insane in France.

in the afternoon, and there found Hargreaves, in a refractory cell, alone. The cell he described as flagged, eight feet square, having no fire-place nor window, and being ventilated by means of a small piece of perforated zinc let into one of the walls. The man had no article of furniture, nor any bedding, except two old ragged rugs; and in this place he had been confined, without fire, without any means of washing himself, and without changing his clothes, from ten o'clock on Tuesday morning to Sunday afternoon (five days and a half), with the exception of the few minutes that he was before the guardians on the Wednesday. It was stated that the man was twenty-nine years of age, and that he had been in an asylum before; also that there were nine applications before that of the relieving officers for his admission into the West Riding Pauper Lunatic Asylum. Mr. Tew said he would not sign an order for the man's commitment on the certificate of the union surgeon alone. Another surgeon was obtained, and the order signed.

the old cells; an iron bedstead with excellent bedding, him on the preceding day, he went to the workhouse a chair, and a table, form the furniture of each room; the number of physicians has been increased, and that of the employés charged to watch over and attend the patients has almost been doubled. The patients take their meals in common in vast refectories, comfortably furnished. They are served in earthenware vessels; each has an iron spoon and fork, a knife, and a cup. The meals are preceded and followed by a prayer. At Bicêtre the prayers are chanted in common by the patients. Formerly, the clothing allowed was made to last three years. The state in which the clothes were after such long service, especially those worn by the infirm or the aged, who are generally not remarkable for cleanliness, may be imagined. In 1841 only 13f. a year were allowed at La Salpêtrière, and 11f. at Bicêtre, for the clothing of each patient; but at present nearly double the sum is granted, and the clothes are replaced when unfit for use, without regard to the length of time they have been worn. In the two asylums at Bicêtre and La Salpêtrière, 1343 patients work with acuteness which astonishes all visitors. Moreover, work is for these unfortunates a source of profit, and thereby they are able to procure some little VACANCY. The appointment of Clinical Assistant at comforts not included in the ordinary regime of the the Oxfordshire and Berks County Asylum is vacant. establishments. Finally, to amuse the patients and The salary is £70 per annum, with board. Information break the monotony of their stay at the hospital, respecting the duties may be obtained of W. Ley, games, singing, gymnastics, drives in the country, Esq., Superintendent of the asylum. etc., are allowed. These experiments have produced the best results.

DETENTION OF A LUNATIC IN A UNION HOUSE.-At the court of the WEST RIDING Justices, at WAKEFIELD, on Monday, February 20th, the magistrates were asked by the union officers to sign an order for the commitment of a man, named Henry Hargreaves, to an asylum, as a lunatic. The Rev. Hugh B. Smyth stated that, in consequence of representations made to

HANTS COUNTY LUNATIC ASYLUM.

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To Correspondents. A VISITING PHYSICIAN.-Our Correspondent's letter savors more of the fish-market than of the forum. If he will have the kindness to correct this defect, and authenticate his statements with his name, we shall be happy to enter into any enquiry respecting the peculiar government of the institution to which he is attached, and its results upon the welfare of the patients.

W. LEY, ESQ. The preparation used is the Tincture of the Per

nitrate of Iron: dose, from ten to twenty minims in peppermint water. An excellent remedy in the diarrhoea of general paralytics and other patients of feeble powers, when inflammation does not exist, and opium is contraindicated.

Works on Insanity and Cerebral Disease, published by
S. Highley, 32, Fleet Street, London.

NOTICE. The VISITING JUSTICES of the PHYSIOGNOMY OF INSANITY

HANTS COUNTY LUNATIC ASYLUM are desirous of receiving applications from duly certified Medical Gentlemen to perform the duties of SUPERINTENDENT OF THE LUNATIC ASYLUM, at Knowle, near Fonham, in the said County. All candidates wishing to tender their

services to the Committee of Justices for the above purpose are hereby directed to send in their applications, together with Testimonials, to the Clerk of Peace's Office, Winchester, addressed to the Chairman of the Hants Lunatic Asylum Committee, on or before Saturday the 22nd of April next.

A

GENTLEMAN who has just resigned an
Appointment as MEDICAL SUPERINTENDENT OF

A SERIES

of Photographic Portraits from the Life, by DR. HUGH W. DAIMOND, F.S.A. With Brief Medical Notes. To be published in occasional parts, small quarto.

ON THE INCUBATION OF INSANITY. By

FORBES WINSLOW, M.D., &c. 8vo. 2s.

INSANITY

TESTED BY

SCIENCE, AND shown to be a Disease rarely connected with Permanent Organic Lesion of the Brain. By C. M. BURNETT, M.D. 8vo. 5s. ON THE NATURE AND TREATMENT OF SOFTENING OF THE BRAIN. BY RICHARD ROWLAND, M.D., Assistant Physician and Lecturer on the Principles and Practice of Medicine at the Charing Cross Hospital. 8vo. 5s. CRIMINAL JURISPRUDENCE, CONSIDERED in relation to Mental Organization. By M. B. SAMPSON. Second edition, enlarged. 8vo. 5s.

All communications for the forthcoming Number should be addressed to the Editor, DR. BUCKNILL, A PRIVATE LUNATIC ASYLUM, is desirous of meeting Devon County Lunatic Asylum, near Exeter, bewith a similar situation. The Advertiser has had fore the 26th day of April next.

considerable experience in the treatment of Lunacy,

and can produce the highest Testimonials. Address, PUBLISHED BY SAMUEL HIGHLEY, 32, FLEET 'Medicus,' 1 Lonsdale Place, Notting Hill, London.

STREET, LONDON.

W. & H. POLLARD, Printers, North Street, Exeter.

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Medical Certificates under the New Asylums Act

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REVIEWS.

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The recent Appointment of a Superintendent to the Canada
Asylum

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Report on the Establishment, Construction, and Organisation,
of the best Asylums for the Insane in France and else-
where. Presented to the Committee of the States of
Jersey, &c., by D. H. VAN LEEUWEN, M.D., formerly
Physician of the Asylum of Meerenberg. North Holland. 75
Practical Observations on Mental Diseases and Nervous Dis-
orders, by ALFRED BEAUMONT MADDOCK, M.D.,
8vo. pp. 236. Simpkin, Marshall, & Co., London
MISCELLANEOUS.--Trial and Conviction of an Attendant for
the neglect of a Lunatic Patient at Norwich
ASSOCIATION NOTICES

73 APPOINTMENTS

77

78

80 80

Medical Certificates under the New Asylums Act. The alterations of the law on the subject of medical certificates are numerous, important, and highly creditable to the framers of the new statute. We subjoin an enumeration of them, with a few remarks on each.

nature that a patient, insane when examined, may have become well before eertification and removal. Such cases, however, do occasionally happen, and indeed we have seen several such cases under the old law, recovery having undoubtedly taken place between certification and admission.

1. In the old act the medical officers of Unions This alteration will enable the examining medical were placed, from what motive it is hard to conceive, man to deliberate well before he certifies. It will also under disability to sign these documents. In many enable the union medical officer, who becomes aware, thinly peopled districts, all the medical practitioners by observation not pre-arranged, of the insanity of a are union officers, and it consequently became, under chargeable person, to communicate the same to the the old law, no easy matter to obtain the examination proper authorities, and to certify without further and certification of a lunatic pauper. Considerable examination. Circumstances will not unfrequently expense, and time often more precious than money, arise, wherein much valuable time may be saved by was lost either in procuring the attendance of a medi- the facilities thus offered. cal man from a distance, or in sending the patient to some town for the purpose of being examined. In parts of the country where these inconveniences were not felt, the pauper patient had still to be examined by a stranger to his person, his peculiarities, and his case, while the attendant likely to be acquainted with all these, to have known the man in health, and to have observed the accession and progress of disease, was thrust on one side as untrustworthy. This absurd anomaly is now rectified.

3. The certificate must be signed by a physician, surgeon, or apothecary, who must be duly authorised to practise as such by some institution legally qualified to grant such authority in some part of the United Kingdom, and who must be in actual practice.

The old statute did not indicate who should be considered physicians, surgeons, or apothecaries; and therefore left it possible for the liberty of British subjects to be abrogated on the certificate of any one who had purchased a foreign degree, or assumed a 2. The medical man is no longer required to sign fictitious one. It is also a reasonable proviso that the the certificate on the same day the examination has certifying physician, surgeon, or apothecary must be been made, but may sign it three days afterwards. in actual practice. This will prevent any future abuses This is a reasonable and expedient change, justified similar to one with which we were acquainted, whereby the fact, that insanity is rarely of so transitory a by a retired physician, whose diploma dates in the last

century, was under contract with the guardians of a union to certify to their insane poor, at the rate of five shillings each case. The excuse for such an arrangement being the difficulty of obtaining the services of any other medical man, as all others in the neighbourhood were union officers.

4. The new statute requires the certifying medical man, not only to state his professional qualification, but the profession or calling and the residence of the patient, and the date and place of the examination. These alterations were needful to render the certificate a precise and valid document. The old form was, in fact, without an address, and in the event of a dispute and the death or absence of the certifier, it might, in consequence of this defect, be impossible to ascertain under what circumstances the examination took place. The insertion of the residence and calling of the patient was also necessary for legal precision. The old form, which attested that some ‘John Smith' had been examined and found insane, is now replaced by a form which attests that a certain particular 'John Smith, tailor, of Noman street, Weissnichtwo,' for instance, had been so examined and ascertained to be of unsound mind.

5. The additional stringency of the clause enacting that when any patient, not a pauper, is sent to an asylum on one medical certificate only, two other certificates from other medical men shall be obtained within three days of admission, is just and reasonable. It will probably be effective in rendering such admissions of rare occurrence. Circumstances necessarily and imperatively preventing the examination of a patient by two medical men before admission cannot, indeed, take place very frequently, if due pains are taken to obviate them; and it is certainly undesirable that the liberty even of a suspected lunatic should be left to the decision of a possibly interested relative, and a single medical man.

6. The most important change of all consists in the certifying medical man being required to state the facts upon which he founds his opinion of insanity; distinguishing those observed by himself from those communicated to him by others; the former alone being admitted as a valid ground of opinion, the latter being held as merely corroborative. It is probable that under the repealed statute the above order was not unfrequently reversed, the opinion of the medical man being formed upon the testimony of others with very slight corroborative observation of his own. There can however be no doubt that the course at present prescribed is the only right one. It is the duty of another profession to estimate and balance testimony, and if the labour of doing so is ever incurred by the medical man, the information so derived must be held by him in a place strictly subordinate to that obtained from his own observation. The medical man is employed to examine as an acute and practised observer; and were the testimony of others sufficient, it does not appear certain that he would be required at all. Besides he certifies that the patient is insane at the time of the examination, not that he has been insane at some prior period indicated by the testimony of others, and such opinion must of course be founded upon facts discerned by himself.

It has been objected by an asylum proprietor writing on this subject to the Provincial Association Journal, that in certain cases of emotional insanity the medical man would experience the greatest difficulty in certifying from facts observed by himself; that in such cases no intellectual aberration exists, and none therefore can be observed; and that the emotional perversion is frequently to so great an extent under the control of the patient, that it may be impossible to elicit a display of it in the presence of the medical examiner. Such difficulties will no doubt arise, although we apprehend not very often. When they do occur they must be met by increased diligence on the part of the examiner to arrive at a personal knowledge of the facts. In ordinary cases these may be obtained to a sufficient extent at very little expense of time or trouble; but in such extraordinary cases the examiner will be unable to draw just inferences and to discharge his duty without repeated interviews; it may even become necessary that he should avail himself of opportunities for observing the conduct of the suspected lunatic in his work or his amusements, or his behaviour towards his relatives. By the exercise of such diligence, where insanity does exist it cannot in the end fail to be observed either displaying itself in abnormal states of mind, intellectual or emotional, or in conduct not otherwise explicable. We are surprised that any medical man could think it justifiable to certify to the insanity of a patient, on facts alone communicated by others. Such a proceeding would indeed be tantamount to an assumption of judicial functions and a renunciation of the duties and peculiar responsibilities of the physician.

7. The new statute agrees with the old one in making it a misdemeanour to receive a patient into an asylum without the order and medical certificate: but differs from it in making the statement of particulars equally essential. It however, by sec. 87, permits incorrect or defective orders or certificates to be amended by the persons signing the same within fourteen days of the admission of the patient.

We cannot think this section either a wise provision in itself, or consistent with the other parts of the statute. It has already been a fruitful source of irregularities. The act in fact contemplates the continual commission of misdemeanours by officers of asylums, and the 87 sec. is made to stultify the 73.

Under the old act the admission of patients brought with irregular and defective certificates was simply refused, unless the superintendent or relieving officer was willing to incur the risks of a misdemeanour imposed on him by the ignorance, stupidity, or wilfulness of some relieving officer or justice's clerk. Under the new act it appears that he is expected to admit the patient, notwithstanding the misdemeanour; and as to the irregular and defective orders and certificates, he is "to procure the same to be forthwith amended." (Circular of Commissioners, Dec. 31, 1853.) And when one of the Commissioners in Lunacy have approved the amendment, "such formal sanction" will serve "for the protection of superintendents and proprietors against vexatious legal proceedings." (Circular of Commissioners, Dec. 12, 1853.)

One would suppose it a more simple and satisfactory

plan to insist upon the papers being right at first, than to provide such a complicated system of checks and counterchecks. Besides the act provides no means whereby the officers of asylums may procure amended forms forthwith, or immediately, or indeed at all.

curred in procuring such forms. The copies of the amended forms are sent to the Commissioners in Lunacy, who are therefore not called upon to give their sanction to the amendment. We cannot vouch for the legality of this proceeding, but it seems to work well.

The patient once admitted and safe in the asylum, the persons who sent or brought him may or may not, as they think fit, take the trouble to obtain amended forms. The act makes no one responsible for this The recent appointment of Superintendent to the Lunatic duty, which is clearly beyond the province or the power of any officer of the asylum to fulfil.

Asylum in Canada.

Our readers must remember that a few months since daily advertisements appeared in the Times, and frequent ones in the medical papers, inviting medical men experienced in the treatment of the insane, to apply for the vacant appointment of superintendent to the Government Asylum, Toronto. Salary, £500 per annum, with the best of good living, &c. The asylum men in this country thought the invitation to be a bonâ fide one (perhaps on account of the pertinacious ad

It is moreover not always possible to distinguish those imperfect forms which are capable of amendment from those which are not so. A vast number of certificates have been defective because they did not state the professional qualification of the certifier. This omission was in most instances found to arise from negligence only, and could therefore be remedied; but in others the certifier was found to possess no qualification enabling him legally to certify, such conse-vertising), and several most eligible and experienced quently could not be amended "by the persons signing the same," and the asylum officer who had admitted a patient under the belief that the defective papers could be readily amended, found that the certificate and the order were from this cause illegal and worthless.

men applied for the appointment; collected, printed, and forwarded testimonials, sufficient to persuade Minos, incurred considerable expense, and an enormous amount of anxiety. We fear that an old and esteemed friend, who justly reposes much confidence in his personal powers of persuasion, has even gone to the One other consideration, having no reference to the length of crossing the Atlantic, and facing the rigours statute, but some at least to common sense, is that if of a Canadian winter, in order to canvass the comthe papers are sufficiently complete to justify the ad-mittee of visitors. We have not heard of him since mission of a patient into an asylum, they would seem the advertisement. And now all this energy of search, to be more than sufficient to justify his retention there, so long as the medical officers of the asylum think it necessary to detain him. When a patient is brought for admission, the superintendent seldom knows anything of him, except through the legal documents. If these are sufficiently complete to justify the patient's admission, it would seem that their mission has ended, and the responsibilies of the medical officers of the asylum have begun.

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The statute states that "no such amendment shall have any force or effect, unless the same shall receive the sanction of one or more of the Commissioners in Lunacy." But the circular of the Commissioners directs the officers of asylums to procure irregular or defective papers to be amended forthwith. It is not easy to obey both the statute and the circular, and in this point, we apprehend, that the statute is generally neglected. When a patient is brought to us for admission, with irregular or defective papers, we only admit him after the relieving officer or overseer who has brought him has signed an undertaking to procure amended forms within a certain date; or, in default thereof, to reimburse to the asylum the expenses in

this strenuous attempt to discover the best man for an important office, turns out to have been a mere feint; the gentleman predestined to superintend the lunatics of Canada was all the time occupying the place as locum tenens; locum tenax, would perhaps be nearer the mark. They do these things in Canada as well as if they had taken a lesson in the city of London itself.

The disappointed candidates, feeling themselves to have been cheated of labor and money and anxiety, and to have been wheedled into troubling their committees and their friends on a fool's errand, are justified in not feeling qnite amiable on the subject. But is there no balm in Gilead, no balsam in the pharmacopæa of philosophy, capable of healing the wounded scarf skin of their sensibilities? Let them remember that when a body of gentlemen are determined upon perpetrating what is vulgarly called a job, it is far better that they should outwardly observe the decencies of justice and fair dealing, since by so doing they acknowledge in the eyes of the world that justice and fair dealing are the principles upon which they ought to act. In private life we might say, "Hypocrisy is the homage which vice pays to virtue." But in the conduct of public affairs we are far from saying that this severe maxim is applicable. It was observed by a great man that," Corporate bodies have no conscience," but this is evidently a mistake. When a gentleman as a member of a board or a body of governors participates in conduct for which he would abhor himself as a private individual, he affords no proof that in his corporate capacity he has acted without conscience, but only that the rules of right and wrong in public and in private conduct are capable of transposition. He exemplifies, in fact, the force of

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