The times. [volume] (Washington [D.C.]) 1897-1901, 1901-05-12

4
| ineapaeity where there is no necessity TO
or advantage from hospital treatment
4 For the determination of such a ques
| tion ii is doubtless necessary often [,
have not only the protection of cour
| instructed by medical advice and testi
mony. but the further safeguard of tn,
Judgment of business men and thos.
| whose experience best enables them tC
| determine the question of business ca.
| pacity and safety.
ut will be conceded | think. that whet
any act OF the insane requires the deter
mination of responsibility before the law
the opinion of both judge and jury is q
necessity. There are so many relations
OF the action which is the subject of en-.
qulry IN such case TO the social machine
with its rights and relations that the
Judgment of those who are in as nearly
similar relations with the suspect is nee
essary to determine both the existence OF
the action and its index of the degree OF
responsibility OF the deer.
The disease of insanity differs in no
respect from any other disease as to the
great Importance of early and correct
u, treatment. al ne ! have known many a case
10 be 50 overlooked and so misjudged that
the day OF grace was wholly sinned away
before any thought was permitted of the
adNisabiiity OF any treatment.
Arrangements for the hospital treat
fnent OF the insane. therefore. should be
such as to encourage the patient and his
friends to promptly avail themselves of
IT. To this end the machinery for COM
iiuNisSHl SnOulQ De as simple and unCOin-
pitcated as is consistent with the pro-
lection of the rights of the individual.
above everything else all unnecessary
pupilcity or notoriety should be avoided.
lou may readily imagine how both the
patient and his family would shrink from
SGcn an ordeal and many a case has
drifted into hopeless dementia simply be-
cause of the dread of undergoing the pub
licity of trial
rs /. not cruel practice to hold UP be-
fore curious public such a sad mis-
fortune as an attack of insanity? An en-
quiry by a court should be held as sacred
as the examination of any other patient
by physician. The poor unfortunate is
only an unfortunate. not a criminal and
We have no more right to parade his
calamity before the public gaze than a
physician has to retail to others the Sc
crets OF the consultation room.
1t would seem that the sine qua non
cf commitment should be skilled and
trustworthy medical advice. 1t is surely
the work of a physician to determine the
existence of disease 1t should also be his
duty TO advise as to the proper treatment
of II. This is the whole question.
To properly protect the rights of the
patient in view of the incapacity or unre-
liability of his own judgment 1t is neces-
sary that the testimony should be re-
viewed in the light of an impartial court.
1t should be shown to be competent, in
telligent, and uninfluenced by prejudice or
self-interest. As far as possible the basis
on which it rests should be shown to the
L. IL
that the patient should himself be par
AIDED before the court to be held up to
public view. excited by public examina-
tion. and the symptoms of the disease
often exaggerated by contention and con-
troversy over delusions that are not sus-
ceptible to reason or Influenced by argu-
ment If the impartial attitude of the
judge should disclose any doubt as to the
sufficiency of the testimony there should
by all means be a personal examination
of the patient in the presence of the court
but this should seldom be necessary.
ITO be most effective this judicial pro-
cedure should be available as promptly
as possible and it should be had before
the patient is sent to the hospital ] have
known frequently quite injurious results
to follow an appearance in court after the
patient has been sent to the hospital and
after the excitement of the change.
with every hospital for the treatment
Of the insane provision should be made
also for the admission Of voluntary pa
tients without any Judicial procedure.
Only physicians in certain lines of prac-
tice know how many cases abound in
every community who for months have
been conscious of failing health and ap-
mental confusion and incapac-
ity. Such physicians know toe. that
they are often obliged to temporize and
to advise other less advantageous forms
of treatment simply because an inquest of
lunacy, with its publicity and opprobrium,
is the only means by which access to a
hospital especially fitted for the patients
case is available for those whose means
viii not enable them to pay.
''lt may be urged against such ready
to hospitals FOR the insane
that it would permit many unnecessary
or unjust admissions but ! do not be-
lieve that it would do so. AS matters are
now. far more danger is done to both
patient and society by impediments to the
ready commitment of the insane than by
their unnecessary and unjust contine-
ment. In fact, after an experience Of "A
n q grnhfn rilIR D.srhgnG
1900 cases, Will. ! have known of
number of habess corpus proceedings
which resulted in the release of the pa
lent. / cannot recall q single well eSt2b-
ished case in which its future history
lid not give sufficient proof that the origi-
lal commitment had been justifaole.
"On the other hand. does not the pub
ic press teen with the reports Of tragedy
ifter tragedy. due to the failure of some
me to property estimate the condition of
he patient2 For this neglect ! regret to
iay that he-famiiy physician is often in
Iart to blame. Even among medical men
he notion Is prevalent that insanity does
,ot exist unless there is actual incoher-
nee or established delusions. Self-con-
lemnation, hypOchondTia, melancholy. an
unusually suspicious attitude toward
lthers. or extreme irritation are not often
properly Interpreted. but left to grow and
,rogress until the denouement is an act !
hat starties and shocks everyone by its |
eerful results. 4
ut is a lamentahIe fact that among /
physicians in the general practice of |
Medicine there is much want of knowl I
dge Of the nature of insanity and the |
ndicia OF its diagnosis, prognosis. and |
roper treatment This knowledge can |
My be gained by a personal contact with |
he insane. For this reason II would seem |
I advantage that medical examiners be |
egularly appointed officers of the court. |
elected with reference to fitness and I
allied in all proper cases as the number
hey are called to examine VIII constantly 1
ualify them the better for their work.
There should also be large discretion |
iven the authorities in charge Of every
irge hospital for the care of the insane
n the matter of releases from hospital
reatment.
Every symptom shown by the insane
but the expression of disordered func-
on of physical structures. Let the pub
C be educated so to view it, Let them
ndcrstand that the hospital treatment
Z this disease is no different from the
ospital Treatment Of any other disease !
'hich cannot well be treated in a private
ONE. Make this hospital treatment as
ccessible as any other hospital treat
lent. throwing about it only such safe
yards as its compulsory character may
equire. Encourage the public to take ad-
antage OF this hospital treatment at the |
eriod when IL will be most efficacious"
The discussion which followed these ad-
resses was participated in by a num-
er of sons,-including DR. Frederick
|. W inee. OF the Census Bureau, and WI |
am y. Letchworth. President Of the Ma |
onal Association for the Study of Epi-
psy and Care and Treatment of Ell
,ptics. DR.. Wines made few remarks |
long the lines followed by the speaker
nd said that one thing he felt should be
impressed on the public was that expert
ttention should be promptly given those
isplaying symptoms of insanity. Mr..
etchworth laid especial stress on that
art of DR.. Richardson's address. which
rged the advisability of admission with
lt examination Of persons afflicted with
SANITY who were willing TO allow them
ewes to be treated.
hr. Michael Heymann. Of New Orleans.
poke briefly of the international confer
nee on charities at Paris last year. and |