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429 Correspondence. LUNACY VERSUS LAW AND PHYSIC. "Audi alteram uartem." To the Editor of THE LANCET. SIR,-I beg you will allow me an opportunity to direct the I attention of the profession to the apathy and apparent care- lessness at present existing in the treatment and care of persons of unsound mind. No steps are taken of a sanative nature until some outrageous or even sanguinary act has been com- mitted, and then the patient is sent to an asylum to be con- fined, rather than with the idea of his being placed under a plan of treatment suitable for his case. Obsta principiis is not the motto adopted in the treatment of mental diseases at the present time. One of the causes of this dangerous apathy and delay is, it appears to me, to be found in those injudicious articles which a few months ago appeared in several of the daily newspapers and other journals. The authors of these have now an oppor- tunity of seeing the effects of their miscalled " excellent articles" and " public-spirited letters," written in defence of the liberty of the subject, and for the protection of the Eng- lishman’s fireside. It is to these in great measure that so many distressing suicides are due-that so many uncured lunatics are removed from asylums to become suddenly excited, and to inflict injury on their friends or relatives. Nor is it uncommon to find that medical men decline signing certificates, although conscious that the patient is a proper case for an asylum, until they can safely state that the lunatic is dan- gerous ; for they know that practitioners of the highest re- spectability have had charges of serious import made against them, and have been obliged to appear in the law courts, for performing their duty to their mentally-afflicted patient when the evidence of his alienation was not such as to be patent to everyone at first sight. It not unfrequently occurs that almost as soon as a patient (I here refer to private patients) suffering from insanity is I placed under treatment, even although the most favourable period for that being successful may have passed, a soli- citor is empowered, by some of the so-called friends of the patient, to interfere and to demand his liberation, notwith- standing that medical men recommend delay and advise a con- tinuance of treatment. Their advice is unheeded, and their opinion is treated as that of men whose only motive is to keep the patient in order to receive the payments, and who have no desire for the restoration of the lunatic to reason. If the asylum superintendent adheres to his opinion, and is supported by those who have a true desire for the patient’s recovery, a writ of habeas corpus can be obtained, or, if the patient has means sufficient, the case may be taken before a jury. Now, although a jury may be composed of respectable and honourable men in business transactions, they are not competent to decide on the more delicate indications of insanity; and they consider an asylum only as a prison or place of confinement, forgetting the higher characteristic-that it is for the proper treatment of a peculiar disease. They are also influenced in some measure by the feeling that it is " too bad " to deprive a fellow-creature of his freedom. Unless an amusing delusion arrests their at- tention, or some glaring absurdity of conduct presents itself, they decide that the patient may have been insane, but is not so when brought before them. They believe that they are quite as able as "the doctor" to decide; in fact, that anyone can tell whether a man is mad or not. Thus the evidence of the physician, who is best acquainted with the patient’s state of mind, is set aside as that of an interested party, and he may congratulate himself if he leave the witness-box without being insulted or treated with indignity; whilst the jury return a verdict which does more credit to their hearts than to their sagacity and discrimination. In illustration of the error of the system, I may here remark, that such a jury might be able, when a man had cough, spat blood, and became emaciated, to decide that he suffered from consumption, or, in another case, that violent palpitation, difficulty of respiration, and cedema of extremities, indicated heart disease; but they are not able to tell of the earlier and more important indications of phthisis, of the gradual deve- lopment of cardiac valvular disease; nor from the copper- coloured spot of lepra could they diagnose the constitutional contamination existing. All these are left to the physician; and the more a man devotes himself to a special branch oj these diseases, the more is his opinion relied on. Not more obscure nor less important are the indications of insanity in many cases, nor less difficult of diagnosis are the symptoms; but those who have the best opportunity of forming an opinion are not relied on; and unless something as evident as haemop- tysis in phthisis, or violent palpitation and dyspncea in heart disease, is observable, the jury do not detect that the man is insane, nor do they perceive that a plan of treatment is as necessary for the partial lunatic as it is for the subject of con- sumption or syphilis. Their knowledge is insufficient to teach them that retirement in an asylum, or away from business or relatives, is more necessary for the recovery of the mentally alienated than change of scene and climate for the subject of the former disease. In my opinion, a non-professional jury is not fitted to decide in cases of insanity, for the members of it judge only from exaggerated indications, and evidence is not wanting to prove the truth of this observation. To show that the preceding remarks are not uncalled-for, a few recent cases are adduced: the first, to indicate the danger to the patient himself, incurred by premature removal from an asylum; the second, to show the danger incurred by objects of his suspicion; and the last, to illustrate the wrong that is done by delay in placing the patient under proper treatment. Some months ago, a gentleman in good position in business showed evidence of mental alienation. There was no positive delusion, but his conduct attracted attention, and his habits, previously steady, became dissipated. He soon conceived the idea of becoming member of Parliament for a borough in which there was no vacancv. and pnblished circulars, and 1)araded the streets accompanied by a large dog and a horse adorned with blue ribbons. He associated with the worthless and noto- rions, and, having money at command, became their prey. The police at last were compelled to interfere, and his friends were applied to that he might be taken care of and sent to an asylum. When admitted, he showed symptoms of incipient organic cerebral disease; but his mind was only so much affected as to be classed as a case of partial insanity. Through the interference of some who called themselves his friends, he was soon removed from the only place where he was likely to receive benefit; but having been restrained for a period from dissipation, he left in a relieved state. Under no supervision, he soon again became the prey of the designing and needy. After a period of excitement and dissipation, during which he unjustly charged his son with embezzlement, the mental agita- tion subsided, and the succeeding depression commenced. But this was only a phase of the disease; he had not recovered. He confessed to his family that he was ashamed of his past conduct, and, under their supervision alone, he remained at large, depressed and melancholy. He attempted suicide by poison and by a razor; but his children, remembering how they had previously been accused of desiring to get his business into their own hands, were deterred from again sending him to an asylum. An attendant at home had been found to be of little use. At last, one morning the family were disturbed by the explosion of a pistol, and, on reaching his room, found him stretched lifeless on the floor. To whom was this man’s death due? Had the case been subjected to a jury when the patient was in the asylum, the medical men would have been disbelieved; and yet such a re- sult was not unexpected, nor was it difficult to the practised eye to diagnose that disease of a serious nature would become developed. The next case shows the danger to others when a lunatic is prematurely removed from an asylum through indiscreet inter- ference. In this case, too, I believe a non-professional jury would have decided that the patient was not a proper case for an asylum when he was first placed under treatment, although, to the unprejudiced mind, there was sufficient evidence to prove the necessity for it. Within a week of his removal, he was again placed in an asylum, as the following notes show. The case is abridged from the reports of police cases in the daily papers. It is headed " A Singular Case of Assault." Is it " singular" that a lunatic should assault those he suspects when he is not under any control ? The lunatic was charged at the police court "with commit- ting a violent assault on his brother." A legal gentleman stated that he "had been drinking very hard of late, and while he was inebriated acted like a mad·_nan.’’ " "The complainant stated that his brother (the defendant) conducted himself in a very extraordinary manner on Thurs- day from morning till night. A man came opposite the shop with fire-wood, when the defendant took up a large cheese- knife, and said forty-two bundles of wood for a penny were cheap enough, and he would soon cut them up. He then
