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report, to recommend that a military lunatic asylum be provided as embraced in the design for the new military hospital at Southampton, while the letter from the DirectorGeneral, which I have printed above, (foot note, p. 271), in reply to the resolutions of this association, leads to the belief that the new military lunatic hospital will be in every way worthy of the nation.
A Letter to the Committee of Visitors of the Surrey Lunatic Asylum, by Charles Snape, Medical Superintendent. Pamphlet. Churchill.
Since the notice given in this Journal of the prosecution of Mr. Snape, the affair has gone through several stages. The prosecution has failed. Enquiry has been made before the visitors of the Surrey asylum, and a Jury of medical celebrities, viz., Dr. Addison, Dr. Sutherland, Dr. R. B. Todd, Dr. Babington, Dr. R. Quain, and Mr. W. Bowman. Consequent on the opinion expressed by those gentlemen, Mr. Snape has been re-instated in his office of medical superintendent. The precise terms of the verdict thus given has not transpired. Mr. Snape has embraced the opportunity of publishing that which he had previously been advised to reserve, his statement in defence. Under the extraordinary circumstances which had enveloped him, he had suffered what few are subjected to. His defence is not pure of the spirit of counter attack, which clears him less than it reflects on others. It is, however, pointed, and contains matter that is well put, that requires professional consideration, and needs to have its value more definitely determined than is to be expected in personal controversy. It is the more necessary that Mr. Snape's opinions should have full publicity, because the Press, seldom neglectful of what is exciting to the public taste, has indulged itself in the publication of attack only, while it is equal publicity that awards popular justice.
It is perhaps unfortunate for Mr. Snape, as it is unfortunate for the profession in lunacy, that the determinate enquiry did not take place in open court.
It is now needless to repeat or expose the deficiency of evidence that the patient Dolly's death was consequent on, as it was subsequent to, his undergoing the shower bath. Snape, however, adds to the information which tended to shew that his decease was irrespective of his treatment. He also
justifies the medical use of the continuous shower bath in the treatment of mania. He says, after five years experience, "I never knew the slightest ill result, and instances can be given of entire restoration to reason, by one single fifteen or twenty minutes continuous bath." It appears, that when the bath cistern is full, the fall of water in the shower bath is rapid, and perhaps heavy; that the supply pipe of that shower bath cistern is not sufficiently large to maintain the full quantity of water to fill the cistern while the shower is in force; that with diminished depth of water, there is less pressure, less rapidity of fall; and that in the continuous bath the depth of water in the cistern is speedily reduced to one third, by which a shower that gives a shock becomes soft and equable.
Mr. Snape considers (probably with accuracy) that continuous shower baths are much preferable to intermittent, and less distressing. He says there are cases in which discharged patients have imputed their restoration solely to the continuous baths of fifteen or twenty minutes.
Mr. Snape is not, I believe, entitled to assume to himself that if on the 8th of April, "I had announced to the public my practice, continuous shower baths would then have been recognized as fresh resources." The profession would have had previous knowledge of the benefits attributed to the use of such baths. The professional mind was prepared to receive that truth, but not as the whole truth.' It is in that further knowledge that the difficulty lies. What are the particular pathological conditions or indications which guide the practitioner to the judicious use of the remedy? For the present the professional mind is not prepared to accept as fact the proposition that continuous shower baths are ordinarily suitable to patients who are maniacal and violent. Mr. Snape quotes Dr. Conolly on the obscurity of pathology of mental disorders. He quotes the opinion of Dr. Elliotson, as published in his Principles and Practice of Medicine, published, I believe, in 1839, but delivered long previously. Fair, no doubt; but what a sarcasm on medical literature, to arraign Dr. Elliotson's early writings against the opinions of his age.
The obscurity of insane pathology has been confessed at a much later period. It may appear to us that Mr. Snape is going back to a dark age for his system of treatment,-a period of ten years distant, or it may be somewhat more! It may appear to him that fashion has made us too decidedly forgetful of what was often good and successful in the practice of that day; that the doctrine of a cool head in febrile affections still lives in the prejudices and practise of a race not yet defunct.
The doctrine of the schools, is always to avoid suddenness and irregularity of force which will induce an irritable or spasmodic condition; and it is the gentle employment of continuous, unrelaxed exertion that will gradually overpower the countervailing force which will never give way if you occasion shock. It does not appear that Mr. Snape administers the shower bath continuously, with benefit, in more than exceptional cases. The profession will wait for guidance before it adopts his practice. He, however, publishes frankly a statement which he has laid before the Visitors of his asylum, in correction of statements made by other officers; and courting contradiction of them if untrue.
Mr. Millar and the Bucks Visitors.
The removal of the Superintendent of the Bucks County Asylum in a manner which has excited the astonishment of our department of the profession, has been the most prominent topic of interest and remark. The letter addressed by Mr. Millar to the magistracy of Bucks, which has been placed in the hands of all the members of the Association, renders it unnecessary to enter fully into the details of this transaction. The point of view, however, taken in that pamphlet differs somewhat from that which will present itself as the one of most importance to our readers. Mr. Millar naturally desires to shew that he has committed no offence worthy of reprobation. The officers of other asylums are less interested in this question, than in the manner in which he has been ejected from his office. If even it be assumed that some serious offence or grave incompetency be imputable to him; yet if the manner of his punishment has been such that it may be employed with equal effect against the innocent and the guilty, the proceedings of the Visitors are justly liable to animadversion. That Mr. Millar was a competent superintendent is probable for several reasons: he had been the superintendent of a large pauper asylum in Middlesex, and in that appointment he had given the highest satisfaction to the Commissioners in Lunacy, under whose immediate supervision he was there placed; he had subsequently organized and for four years superintended
the Bucks Asylum in a manner which had repeatedly called forth the high official approbation of Visitors and Commissioners.
Up to the very day on which he was compelled to assent to the request that he would resign, he had not been made aware that there was the least dissatisfaction with his management of the asylum. It was, therefore, a priori, most improbable that Mr. Millar was other than he had been represented, namely, an active, intelligent, and efficient officer. Either Mr. Millar was an efficient officer, or the Committee and the Visitors had been incapable of detecting his inefficiency during the considerable period he had been under their observation. This line of argument, however, does not apply to the commission of serious offences, and the proof of such offences would not need that the change of opinion of the Visitors should be a gradual one. Such offences being fairly proved might fully justify the summary proceedings of the 15th of August. The whole question turns upon whether they were proved, and how they were proved. If they were proved, the fact of Mr. Millar's dismissal may be justified. But if they were proved in a manner at variance with those usages of free and civilized communities in the investigation of offences and the infliction of penalties, the injury to society will scarcely have been less than if the penalty of ignominious dismissal and probable professional ruin had been inflicted for no inefficiency, for no offence, but to gratify the caprice or egotism of some rural dictator.
We ascertain from the letter of one of the Visitors, published in the Aylesbury papers, and from Mr. Millar's letters, that the manner in which Mr. Millar's offences were investigated at the meeting on the 15th of August, was by the reading of an anonymous letter containing various charges of the most paltry description, and by putting to him questions thereupon in the spirit of a barrister cross-examining a witness at the Old Bailey. After this wonderful exhibition of impartial and candid enquiry, the Visitors informed Mr. Millar that they had no confidence in him, and that unless he resigned they would attend no more meetings; that is, they would interrupt the business of the institution, they would sign no more cheques, discharge no more patients, perform no more the various duties which the statute imposes upon them, and without which the business of the asylum could not proceed.
It has been said, that Mr. Millar was not dismissed, but if this was not a dismissal, it will be hard to say what is. However, Mr. Millar, aggrieved at the manner in which he had been treated, immediately afterwards withdrew his forced resignation. A fortnight after the Visitors again met. Animated by the same spirit they intimated to Mr. Millar that if he consented to resign, they would give him testimonials of character, and on his rejection of this singular proposition, they came to a formal resolution, that Mr. Millar should be removed from his office that day three months, thus ignoring by the date of the actual dismissal the resig nation which they had previously forced upon him.
If the verbal resignation of the 15th of August was held to be valid and binding, the termination of Mr. Millar's services would have taken place in three months from that date, and not at three months from the subsequent meeting, and the Visitors would scarcely have thought it needful to tempt Mr. Millar to abide by that forced resignation by the offer of dubious testimonials.
We shall not at the present time offer any further comments upon this remarkable transaction, because in a few days from the present time the Visitors will have to render an account of their stewardship to the assembled magistracy of their county; and because the matter has been ably taken up by the President of our Association, who has issued a protest, which has been signed, with two or three exceptions, by all our members, thus marking an unanimity of opinion rare among so large a number of professional men. Before issuing this protest, Dr. Hitchman attempted in vain to obtain some explanation of the conduct of the Visitors by the most courteous appeal to the Chairman. But neither to his appeal, nor to those made by Mr. Millar in his pamphlet, and by Magistrates at the Michaelmas Sessions, have the Visitors deigned any other reply than the imperatorial sic volumus, sic jubemus.
The remonstrance of the Association is as follows:
To the Lord High Chancellor of England.
To the Lord Lieutenant and the Magistracy of the County of Bucks.
My Lords and Gentlemen,
We, the undersigned, being Members of the Association of Medical Officers of Asylums and Hospitals for the Insane, beg respectfully to address you upon a subject of the greatest importance, both to the reputation for justice of the magistracy for the county of Bucks, to our own interests, and to the welfare of the insane poor.
The office of Medical Superintendent to the Buckinghamshire County Lunatic Asylum has been held since the opening of the Asylum by Mr. Millar. He was elected after public competition, in consequence of his very high testi