This defective knowledge of insanity and its treatment ought not to be found, were medical instruction complete. But whilst the medical curricula make no requirement of instruction in mental disease necessary to medical qualifications, they are expanded so as to comprehend almost every branch of human knowledge, under the heads of ‘Preliminary Education’ and of ‘Collateral Sciences,’ and yet ignore psychological medicine, as though human beings were without minds, or, at least, without minds subject to disorder. The consequence is, as facts above illustrate, medical men enter into practice with no conception of the varied phenomena of mental disorder; unable to diagnose it; unfit to treat it, and glad to keep out of the way of its sufferers. Some, as before intimated, associate it, in their views, with inflammatory or congestive disease, and treat it accordingly, by blood-letting and the other parts of the so-called antiphlogistic regimen, to the speedy destruction of the patient, by increased maniacal excitement and concurrent exhaustion, or to his extreme detriment in relation to his prospects of recovery. Let us hope that this state of things may ere long be entirely amended, and that medical practitioners may be required to understand disorders of the mind as perfectly as those of the lungs.
Before quitting the subject of this section, a brief comment on the state of the law regulating the transference of weak cases to asylums will not be misplaced. According to sect. lxvii. 16 & 17 Vict. cap. 97, providing for the examination of alleged lunatics prior to removal to an asylum, it is enacted, “that in case any pauper deemed to be lunatic, cannot, on account of his health or other cause, be conveniently taken before a Justice, such pauper may be examined at his own abode;” and that, if found lunatic, he shall be conveyed to an “Asylum, Hospital, or House...; provided also, that if the physician, surgeon, or apothecary by whom any such pauper shall be examined shall certify in writing that he is not in a fit state to be removed, his removal shall be suspended until the same or some other physician, surgeon, or apothecary shall certify in writing that he is fit to be removed; and every such physician, surgeon, and apothecary is required to give such last-mentioned certificate as soon as in his judgment it ought to be given.” A similar provision is made in the case of “Lunatics wandering at large, not being properly taken care of, or being cruelly treated” or neglected by their relatives, by the section next following (sect. lxviii).
Further, by sect. lxxvii., empowering the Visitors of Asylums to remove patients, it is provided “that no person shall be removed under any such order without a medical certificate signed by the medical officer of the asylum, or the medical practitioner, or one of the medical practitioners, keeping, residing in, or visiting the hospital, or licensed house, from which such person is ordered to be removed, certifying that he is in a fit condition of bodily health to be removed in pursuance of such order.”
From the clauses above quoted, it is evidently the intent of the law to shield the unfortunate sufferers from mental disease, where prostrated by exhaustion or by organic lesions, against hasty and injudicious removal detrimental to their condition, or dangerous to life; yet, as already seen, these provisions are inoperative in preventing the evil. Those, indeed, regulating the transfer or removal of patients to or from an asylum are to a certain extent obligatory, and are probably attended to; but it is not so with those designed to protect lunatics from injurious removals under the direction of parochial authorities, as enacted by sect. lxvii. For by this section it is left to the discretion of the medical practitioner called in, to examine the patient, and to certify, in writing, to his unfitness for removal; but much too commonly, according to the testimony of every asylum superintendent, the humane intentions of the law are neglected. This 67th section need, therefore, to be assimilated to the 77th, so far as to make it imperative on the part of the medical man who examines the patient, to certify “that he is in a fit state of bodily health to be removed.”
This is but a slight amendment, but it might save many a poor creature in a totally broken-down, exhausted, or moribund state, from being carried to an asylum far away, only to pine away and die. It is hard to write against the members of one’s own profession, but the details put forth by asylum physicians of the manner in which patients are conveyed to the public institutions, and of the state in which they are received, demand, on the score of humanity, a condemnation of the indifference and negligence which sometimes mark the performance of duties rightly chargeable to parochial medical officers. Partial excuses for these officers may be found in abundance, on account of their usual wretched remuneration, and the too dependent position they occupy in reference to the parish boards appointing them; but no sufficient explanation appears for their withholding a certificate allowed by law, which might prevent the removal of a patient delirious with fever, of one perishing from heart disease or consumption, or of one dying from the exhaustion of cerebral excitement and defective nutrition.
Chap. VI.—Causes diminishing the curability of insanity, and involving the multiplication of chronic lunatics.
Other causes than those already examined are in existence, sending to diminish the curability and to multiply the permanent sufferers of insanity, to be found unfortunately in the character and constitution of the very establishments constructed to afford requisite care and treatment for our pauper lunatics. According to the division of our subject (p. 31), these causes belong to the second head; or are—
B. Causes in operation within Asylums.
§ Magisterial interference. Excessive size of Asylums. Insufficient medical supervision.