ARE THE CLIMACTERICS, IF POOR, TO BE LEFT TO THE MERCY OF FATE? If these ladies had been poor, where would there have been a chance of life, let alone recovery, for them, if they had not been under the guardianship, control and care of the asylum? Are women, because they are destitute, or possessed of too limited means to procure the necessary watching, quiet, freedom from the excitations of domestic worries and environment, either at home or as "voluntary boarders" in an asylum, to be left to die by their own hand, to kill their helpless offspring (as in puerperal mania), or to come to an untimely end from disease or accident unwittingly induced or encountered in the heedlessness and unconsciousness of their mental abberation? The interests of this last unprotected array of the mentally disordered, if these can no longer be certified as eligible for admission into an asylum, demand some provision at the public charge for that special scientific treatment which has proved so successful in the past, and is proving so increasingly satisfactory by the advances in Medico-Psychological knowledge. Owing to there being at present no tentative temporary detention (other than indicated above) without certification of unsoundness of mind, persons not presenting insane symptoms pronounced enough to warrant the medical man entrusted with the examination of the alleged lunatic in testifying to insanity, some cases are exposed to great risk, with, at times, the issue of a tragedy. In a private case suicide occurred within ten days, and in a pauper case within fifteen days of the examination. SHORT PROBATIONARY DETENTION DESIRABLE. From these and other considerations a probationary residence, say of from six weeks to two months in duration in a special institution, which might be called a probationary hospital for the treatment of mental disease, with bright, pleasant, enlivening surroundings, would be invaluable, a proposal which I was glad to observe publicly approved of by Brigade Surgeon and Lieut. Col. Kringle (Proceedings Society for the Study of Inebriety, May, 1874,) and Dr. Batty Tuke. ESPECIALLY IN CASES COMPLICATED WITH INEBRIETY. In reputed insane cases complicated with inebriety such a procedure would be specially advantageous, as such a term of observation, with treatment, would afford time for the resolution of the immediate inebriate phenomena. The cases to which I have referred are not such as would be eligible for treatment in a Home for Inebriates, and would not knowingly be received into any institution of the kind with which I am acquainted. After the subsidence of the insane symptoms in a Probationary Mental Hospital, if there be power to deal compulsorily with inebriates, it may in certain cases be desirable to transfer the erewhile insane but now sane inebriate to a Home for the Treatment of Inebriety. A provision of the character indicated would in the past have prevented much expensive litigation, would have relieved medical practitioners of grave responsibility and heavy pecuniary risk (the cost and anxiety involved in even a successful defense being exceedingly serious), and would have restored to complete mind-health without the disabilities of certified insanity, not a few of the most industrious members of the community, no small number of the hardest brain-workers in the land. THE DUTY AND RESPONSIBILITY OF THE BY CLARK BELL, ESQ., PRESIDENT OF THE MEDICO-LEGAL CONGRESS. In a paper read before the Section upon Medico-Legal Surgery, of the Medico-Legal Society, one year ago, upon the "True Field of Duty of the Railway Surgeon" I defined the Legal position of the Railway Surgeon, especially where he acted as the attending physician of the party injured, and gave my views as to the safe rules he should adopt as governing his professional conduct. They may be thus summarized: 1. Under no circumstances should the Railway Surgeon who has attended the patient, act directly or indirectly as an adjuster of claims in the case. 2. Under no circumstances should the attending Surgeon act as the Attorney of the Railway or other Company, in the matter of the adjustment or settlement of a claim, nor in relation to influencing the patient to settle his claim. 3. As he has been the attending Physician and Surgeon of the injured man, he can in honor take no step against him, or that would injuriously affect his rights. His relation as a Surgeon of the Railway Company, although it may have been well understood by the patient, places the Surgeon under no obligation to the Railway Company to act in the slightest degree with injustice towards the patient. 4. His duties may be defined generally as follows: a. To fairly and truthfully advise the patient of the nature, character and extent of his injuries, if requested so to do. b. To so advise the Railway Officials, Counsel, and Adjuster, though perhaps an exception should be made, in the interest of the patient as to facts and knowledge obtained from the patient confidentially, or in treating the case, which would prejudice the patient's rights and interests. In such a case, were I the private counsel of the Railway Surgeon, I should advise him that, as to such facts or knowledge, his lips should be Read before the Medico-Legal Society, November, 1895, and ordered published in the proceedings of the Medico-Legal Congress. sealed as closely as would be those of a family physician, were he in charge of the case for the patient. c. The entire responsibility of the compromise, adjustment, or defense in the courts of a claim for damages should be left by the Railway Surgeon with the Attorney of the Company and the Adjuster of claims. d. The Railway Surgeon should take no part in it, pro or con, beyond a fair, honorable, conscientious statement of the facts of the case and the nature, character, and extent of the injury to the proper Railway Officials. e. Duty as a witness. In cases where the controversy results in a litigation, his evidence should be that of simply describing the actual facts of the case, the treatment, and to a description of the nature, character, and extent of the injury, holding the scale of his judgment as evenly balanced between the patient and the company as it is in his power to do. In that paper I embodied the carefully prepared views of leading Railway Surgeons upon this subject, (Vide MedicoLegal Journal, Vol. XII, p. 374 et. seq.) from which I make brief extracts because time prevents quoting at length. Surgeon General Nicholas Senn, Vice-Chairman of the Section of Medico-Legal Surgery: ("There has been too much attention paid by Surgeons to the settlement of claims against railroads. The proper function of the Railway Surgeon is to attend to sick and injured as he would to private patients and leave all legal matters to the proper authorities.") Chief Surgeon C. K. COLE, G. N. Ry., Ex-President American Academy of Railway Surgeons, and Vice-Chairman Section Medico-Legal Surgery: * * "The consensus of opinion among both Railway Surgeons and Medical Men generally, as well as the legal fraternity, is that there is too great a tendency for the Railway Surgeon to feel, when litigation on account of damages occurs, that he must be actively partisan in behalf of his company." * "To give clear medical testimony without prejudice or partiality, is unquestionably the chief function of the Railway Surgeon in his relation to the courts; and when he departs from this rule, and shows that his statements are biased, or it is shown that his actions, and especially his treatment of the case prior to the trial, have been those of a partisan, he at once lessens his influence with all concerned, including the court, and loses CASTE with the patient, the railway, and, most important, with himself." Chief Surgeon S. S. THORNE, Vice-Chairman Section Medico-Legal Surgery, Ex-President National Association of Railway Surgeons: "The duties of Railway Surgeons, if well performed, should be satisfactory, if held within strict limits. No going outside." Chief Surgeon W. B. OUTTEN, N. P. Ry. System, ViceChairman Section Medico-Legal Surgery, Ex-President National Association Railway Surgeons: * * * * * "The true line of duty of the Railway Surgeon is essentially the same as that of any honest man." "When he essays the function of claim agent or attorney he ceases to be a surgeon, and essays a function which the nature of his business and training unfits him for.' "The Railway Surgeon should never permit his prejudice to thwart his judgment; partisanship in his position soon leads to not only loss of respect on the part of his employer, but of all with whom he may be brought in contact." "The Railway Surgeon's duty is at times four-fold,—his duty to himself, his duty to his patient, his duty to his employer, and his duty to the community. If he is true to the first two duties, the two last will never suffer." "The true line of the Railway Surgeon, then, must consist in honest, effective knowledge of his function, along with the true, exact, and strict performance of the same." * * * * * * Chief Surgeon JOHN E. OWENS, Chic. & N. W. Ry. Co., President American Academy of Railway Surgeons: "Your communication of the 12th ulto., referring to a short paper on "The true line of duty of the Railway Surgeon,' received. I am fully in accord with your view of the proper relation of the Surgeon or Medical Man, to the cases of railway injuries which he may be called upon to treat. I have never considered it in any sense my duty to go beyond that of Surgeon or Medical Man.” "I have never entered the field of the adjuster of claims, and feel sure that his duties and those of Surgeon and the Medical Man, are incompatible with each other; nor have I ever encouraged our local or district Surgeons to assume the duties of adjuster, or in any such manner meddle with the case." Chief Surgeon B. F. EADS, T. & P. Ry. Co., Ex-Comm. Section of Medico-Legal Surgery: "The Surgeon's duty is to act solely as a professional man, i. e., doing the best that can be done for sick or injured employees, and see that railway companies are not swindled or defrauded by unjust claims brought by employees or passengers. He should in no wise debase his profession by lending himself as a claim settler in the interest of the railway companies." Chief Surgeon J. R. STUART, H. & T. Ry., Houston Texas: "Briefly I am opposed to the Railway Surgeon effecting settlements, of any nature whatsoever with the injured employees of lines under his direction." * * * ("Experience teaches me that expert testimony by |