“The lunacy law does not permit of the establishment of clinics on the lines which have been recommended, nor does it provide for the admission of uncertified cases to the public asylums. This, for the present at any rate, renders nugatory the suggested schemes for affording treatment for incipient and non-confirmed cases of mental disorder, and with that, to a large extent, fail the opportunities for study on which stress has been laid for adding to the knowledge and increasing the efficiency of asylum medical officers.” (p. [10].)
Such weighty opinions as these serve to emphasise a further factor in the urgently needed reform—the necessity for a thorough overhauling of the law of lunacy, so that, while guarding the liberty of the subject, every obstacle should be removed that obstructs patients threatened with the dire calamity of insanity from securing preventive treatment at the earliest possible moment.
In the Lancet of August 5th, 1916, Dr. L. A. Weatherley writes:—
“The great fact that must be continually brought forward in all these discussions is that, according to the reports of the Commissioners in Lunacy, the recovery-rate of mental diseases is to-day no higher than it was in the ‘seventies’ of last century. The ever-increasing difficulty in getting mental cases with small means quickly under skilled care must, I feel sure, account to a great extent for this lamentable fact.”
“Marking time” since the seventies of the last century—how does this condition compare with that of most of the other branches of medical science? Heart disease, diphtheria, tuberculosis, tetanus, sepsis of all kinds, all these troubles and many others have shown unmistakable signs of yielding to the incessant and many-sided assaults of medical research. And, of insanity, all we have to report in this country is “little or no progress for fifty years.” Verily we have buried our talent deep in the ground.
Finally, we may quote from an article the opening sentences of which might have been written yesterday, yet it was published in 1849! It was the fourth report of the visiting committee of Hanwell Asylum. The committee say:—
“In the constitution of the Hanwell Asylum we are also struck by the paucity of the medical officers attached to it. There appear in round numbers to be about 500 patients on the male and 500 on the female side, yet there is only one resident medical officer attached to each department, and one visiting physician for the whole establishment. The inefficiency of so small a medical staff is obvious. If we look across the Channel we find in Paris that the Salpêtrière, with its thousand patients, has four times the number of visiting physicians and ten times the number of resident medical officers. The disproportion between the sane and the insane is here so great that it is impossible under such a system to bring any moral influence to bear upon the afflicted multitude.”
“... There ought to be a more numerous medical staff and a permanent clinic attached to such an institution.... The County Asylum of Hanwell, supported largely as it is by county rates and parish assessments, is as much a hospital as St. George’s or St. Bartholomew’s, and ought to have a medical staff as numerous and efficient as those of any other metropolitan hospitals. While charity might thus be administered upon the highest principles of Christian benevolence, something ought to be done to advance our knowledge of science and thereby enable us to relieve the afflictions of suffering humanity.”
The dust lies thick upon this volume, published a short time before the Crimean, not the present war. And to-day, like this early Victorian committee, we still ask for clinics, we still ask for scientific work to be carried out by a more numerous and better equipped staff, we still look across the Channel with admiration—in short, approving the better, we follow the worse. We have dawdled away half-a-century and more in comparative idleness. Now the war has taught us our lesson. Are we to forget it again?
Excuses for inertia, brought forward before August, 1914, can be accepted no longer. The thousands of cases of shell-shock which have been seen in our hospitals since that time have proved, beyond any possibility of doubt, that the early treatment of mental disorder is successful from the humanitarian, medical and financial standpoints. It is for us, not for our children, to act in the light of this great lesson.