The record-union., 1897-11-07
WANTS CARE EXERCISED.
Circular From General Superin-
tendent Hatch.

tendent of the State Commission in
Lunacy, is taking steps to prevent the
several State Asylums from be used as
Kelley cure establishments. In many
instances, particularly in the South
ern California Asylum, patients suffer-
ing from the effects of alcoholic slim
ulantS, have been admitted for periods
aggregating sixty days, and to elimi-
nate that class of patients Dr. Hatch
has addressed the following letter to
each of the 354 Medical Examiners in
lunacy in the State:
Dear Doctor: AS you have quail
flied as a Medical Examiner of the IN
sane under the new lunacy law, it is
deemed advisable by the State Commits
ion in Lunacy to communicate with
you regarding examinations under the
present system.
THE recently adopted law makes the
commitment of a person alleged to be
insane more of a medical than a legal
proceeding, and it is therefore doubly
important that Examiners should ex-
ercise great care in the investigation OF
those charged with insanity. The form
for examination issued by the Commits
sion is pretty complete, and if filed out
in detail will give full information to
hospital physicians. The physical ex-
animation should be as complete as
possible and the results carefully noted
on the blanks, for in times not long
past the neglect of such an examlna-
ton has affected the lives Of individ-
ualS who We're committed and sent to
asylums While suffering from acute dis
eases that rendered travel and transfer
to an asylum fatal move. The Com
mission recognize the fact that the fee
for the full examination desired is Of
ten inadequate but the duty is a public
one and in fulfillment Of one of the
greatest of all State charities.
Care should be taken in the use of
medical terms in commitments, and in
this connection there seems at times to
be misunderstanding of the term hal
lucination, illusion and delusion. Briefly,
an hallucination is the perception of an
object as a real presence without a real
presence to justify the PERCEPTION. An
illusion is. the perception of an object
actually present but in characters
which that object does not possess. A
deluSion is a belief in something i'm
possible in the nature of things and cir
subject cannot be reasoned by adequate
methods for the time being.
"As aiding 10 some extent in naming
the form of mental diseases, it will be
well to agree on some simple classifca-
ton that will render the diagnosis more
comprehensive and yet not touch on
disputed points in classification. The
most practical classification for our
purposes may be based upon a division
of mental states into:
"F'irst-States of mental depression,
under which we have melancholia (sin1-
pie, acute, chronic, delusional, melan-
choly with stupor, recurrent, agitated)
''Second-States of mental exaltation
in which may be included mania (sim-
pie, acute, chronic, recurrent, delusion-
alp
"Third-States of mental weakness
which may be subdivided into demen-
tia (primary, secondary, senile, organ
ic) idiocy and imbecility If to the
above we add epileptic insanity, gem
eral paresis paretic dementia) and par
anoia, it will cover the requirements
without touching disputed questions
The above terms with the possible ex-
ception of paranoia define themselves
to physicians. Paranoia may be ex-
planned as a condition of which chronic
and systematized delusion is the essen
tial sign The majority of cases COM
mitted will be embraced by this class
ification, but the many other recogniz-
able forms may be added if Examiners
desire to give a more precise expression
of their views.
''fspfnT-o h. ~,
expresses the hope that you give special
attention to the examination of those
persons suffering from the excessive use
of liquor or drugs. As the law con-
templates that only insane shall be
committed to State Hospitals, it is re-
quested that you hold cases OF inebrie-
ty or morphinism sufficiently long to
enable you to certify that the case is
one of actual insanity before certifying
to it. The law allows you twenty days
for observation of any case and much
less time than this will generally en-
able you to ascertain the true nature
of the case, and justify you in refusing
sanction to committal as insane.
"A distinction is to be drawn between
a prolonged departure from the normal
modes of thinking and acting that NAV
be due to the action of alcohol on an
unstable nervous system, or to the sec
ondary and more lasting effects of liq-
uor; and the temporary delirium, or ex-
element OF acute alcoholism or drunk
enness. In the first case, the indiyid-
ual needs and is entitled to commitment
and treatment in a hospital for the IN
sane; in the second, treatment and rest
for a few days to allow elimination of
the alcoholic poison when recovery re-
suits and the patient can be dismissed
with the verdict drunk but without
having to bear the burden of having
been judicially declared insane.
Finally. the Commission earnestly
case carefully, for commitment to a
Hospital for the Insane deprives one
of liberty, home, family, and in
measure legal rights. and the proceed
ing is so serious in it's nature that the
health, happiness and future of the in
dividual is largely left to your profess
ional Judgment. The Judge is behind
you at all times to ratify your action
and to assist you in investigating the
case. Call on him to assist you in any
doubtful case that you may get at the
true situation which is not always
made manifest by a. strictly medical ex-
animation as through him you can
learn much that may be sought to be
hidden that has an important bearing
on the case before YOU"
Scandinavian Rail-