The times., 1901-05-12

| fncapacity where there is no necessity 70
| or advantage from hospital treatment
For the determination of such a ques
tlon 1t is doubtless necessary often [,
| have not only the protection of a 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 (,
determine the question of business ca
| pacity and safety.
| 1t viii be conceded I think that whe,
! any act Of the insane requires the deter
! miuatiOn of responsibility before the law
! the opinion of both judge and jury is
! necessity. There are so many relation!
/ of the action which is the subject of en-
! quiry in such a 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 doer.
! The disease of insanity differs in nc
| respect from any other disease as to the
/ great Importance of early and correct
treatment. have known many case
/ TO be so overlooked and SO misiudged that
! the day Of grace was wholly sinned away
/ before any thought was permitted of the
| adNiSability Of any treatme
Arrangements for the hospital treat
ment of the insane. therefore. should be
/ such as to encourage the patient and his
friends to promptly avail themselves OF
1t To this end the machinery for com
mltment should be as simple and uncom-
piicated as is consistent with the pro-
| tectlon OF the rights of the individual.
ABOVE everything else all unnecessary
publicity or notoriety should be avoided
| GU may readily imagine how both the
patent and his family would shrink from
SGcn an ordeal and many a case has
orifted into hopeless dementia simply be-
cause of the dread of undergoing the pub
! liCity Of a trial
Tore curious public such a sad mis-
fortune as an attack of insanity? An en-
qulry by 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
II would seem that the sine qua non
Oh 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-
viewer in the light of an impartial court.
II should be shown to be competent. in
telligent, and uninfiuenced by prejudice or
self-interest. As far as possible the basis
on which it rests should be shown to the
court. But IT is by no means necessary
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. II 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.
ha off fx~,4 - Il fr,l
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
tieuts 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 too, 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
will not enable them to pay.
1t may be urged against such ready
to hospitals Tor the insane
that il Would permit many unnecessary
or unjust admissions, but ] do not be-
lisvc that II 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 confne-
mont. In fact, after an experience cf a
quarter Of q century. embracing perhaps
g.y0U cases. while / have known of q
! frra4E al nu he
y hich resulted in the release Of the pa
-ient. ] cannot recall q single well estab-
ished case in which its future history
lid not give sufficient PROOF that the Origl-
laI commitment had been justifiable.
con the other hand. does not the pub
ic press teen with the reports Of tragedy
after tragedy, due to the failure Of some
]ue 10 properly estimate the condition of
he patient? For this neglect / regret to
;ay that the family physician is often in
lart TO blame. Even among medical men
hC notion Is prevalent that insanity does
Tot exist unless there is actual incOher-
nee or established deluSiOns. Self-cOn- |
lelnuatiCH, hypOchOndria, melancholy, an /
unusually Suspicious attitude toward |
,theTs. or extreme irritation are not often |
'roperiy interpreted. but left to grow and |
]TJEress until the denOuement is an act !
hat startles and shocks everyone by its 1
earful results. 4
physicians in the general practice of /
Medicine there is much want of knowl- /
dge Of the nature Of insanity and the /
ndicia OF its diagnosis, prOgnCSiS, and /
'r9per treatment Tins knowledge can /
My be gained by a personal contact with !
he insane. For this reason it would seem /
4 advantage that medica. 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
ualify them the better for their work.
There should also be large discretion
iven the authorities in charge of every
arge 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 disordercd func-
ion Of physical structures. Let the pub
C be educated so TO view II. Let them /
Understand that the hospital treatment !
T this disease is no different from the !
Ospital Treatment Of any other disease 1
'hich cannot well be treated in a private |
ONE Make this hospital treatment IS
1ent, throwing about it only such safe
yards as its compulsory character may
equire. Encourage the public to take ad- I
antage OF this hospital treatment at the |
eriod when it will be most efficacious."
The discussion which followed these ad-
reSSes was participated in by a num- |
CT OF persons, including DR. Frederick
J. ines. OF the Census Bureau. and VIII |
am p. Letchworth. President Of the Ma
onal Association for the Study Of Ep-
-psy and Care and Treatment Of ECi-
sptlcS Dr- v ines made few remarks
long the lines followed by the speaker
nd said that one thiag he felt should be
on the public was that expert
ttentiOn should be promptly given those !
isplaymg symptoms Of insanity. Mr. |
.etchworth laid especial stress on that
art Of DR.. Richardson's address, which
rSed the adyisability of admission with
at examination OF persons afflicted with
lsanity who were willing TO allow them
elves to be treated.
Mr.. Michael Heymaun of New Orleans.
poke briefly of the international confer
nee on charities at Paris last year, and