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OFFICERS AND AUTHORS OF THE MEDICO-LEGAL CONGRESS.

HON. NOAH DAVIS, N. Y. City,

T. D. CROTHERS, M. D., Hartford, Conn., Ex-Chief Justice N. Y. Supreme Court,

Vice-President Medico-Legal Congress. Vice-President Medico-Legal Congress. HON. MORITZ ELLINGER. S. B. W. MCLEOD, M. D., of N. Y., PAUL GIBIER, M. D., of N. Y.,

Sec'y Medico-legal Congress. President Medico-Legal Society. Vice-President Medico-Legal ConCor. Sec'y Medico-Legal Society.

gress. GEO. B. MILLER, M. D.,

M. LOUISE THOMAS, of N. Y., FRED'K L. HOFFMAN, F. S. S., of Philadelphia Vice-President Medico-Legal Soc.

of New Jersey.

Author and Sociologist. GEORGE L PORTER, M. D.,

of Bridgeport, Conn.

WHAT SHALL WE DO WITH. ALCOHOLIC

INEBRIATES AND OTHERS
APPARENTLY INSANE?

BY NORMAN KERR, M. D., F. L. S.

Vice-President International Congress of Medical Jurisprudence; Consulting Physician Dalrymple Home for the Treatment of Inebriety; President Society for the (British) Study of Inebriety; Chairman British Medical Association Inebriates' Legislation Committee ; Vice-President Medico-Legal Congress of

1895.

PAUPER CASES. The present English procedure with alleged "lunatics” or persons of unsound mind, a large proportion of whom are intemperates, though greatly improved by the Lunacy Acts of 1890 and 1891, is still far from satisfactory. Some few years ago considerable and harassing experience, when certifying as to the alleged insanity of individuals stated to have been of unsound mind, nearly a third having been alcoholic inebriates, concerning whom proceedings had been taken with a view to their transfer to an asylum, first forced upon me the conclusion that a temporary detention in a special institution, for a limited period, without the sufferer being declared insane, would be a practical and happy solution of a difficult and intricate problem. Alleged lunatics sent into the workhouse on a summary reception order by a relieving officer, constable, or overseer, can claim discharge on the expiry of three clear days, unless the justice declare the detinue to be a lunatic, idiot, or person of unsound mind. In these cases the jnstice cannot legally make an order to detain the patient,

Read before Medico-Legal Congress, New York, September, 1895.

thus received into a workhouse, one day longer except on declaring the individual to be insane.

Under Section 21 a justice, where immediate care and control are required, may make an order for an alleged lunatic to be received in a workhouse (this proceeding is rarely applicable, as it is generally impracticable to secure a justice at the moment when such an urgency occurs); but even this order is in force for only fourteen days, after which time the person cannot be further detained unless the judicial authority declares him insane.

Case after case occurred, the procedure before a justice having usually been at the instance of a relative or of the police, in which, though the alleged lunatic (alcoholic or non-alcoholic) had been violent or suicidal, or otherwise uncontrollable, while at home or in the streets, admission into the workhouse insane wards had an almost immediate beneficial effect. In some cases, by the expiration of the third day, the insane symptoms had subsided (partly from the change of environment having removed the causes provocative of mental disturbance and excitement inseparable from the former surroundings, partly from the withdrawal of the anaesthetic, partly from the influence of control, discipline, compulsory nourishment, and medical care). In such favorable circumstances, the total disappearance of the abnormal mental symptoms, even in cases which were known to be the subject of alcoholic brain disease, left only one course open, viz: to decline to certify that the individual was of unsound mind. In these cases no other procedure was possible under existing law, and the persons reported on were therefore discharged. In other cases, though the symptoms of mental disorder had partially subsided and were subsiding, giving hope of the complete restoration of reason in a week or two, it was legally impossible to detain the mentally afflicted without the

justice declaring him or her insane, and then in suspending the order for reception in an asylum, for any period not exceeding fourteen days. Sometimes during that interval patients recover and are discharged; sometimes they do not so speedily recover, and, after all, have to be sent on to an asylum.

NON-PAUPER CASES. In non-pauper cases there is at present, except the workhouse, practically no place other than an asylum where the presumably insane (here I speak of such unruly or dangerously violent or suicidal cases, as cannot be restrained at home) can be looked after (whether sent in on an urgency order or by petition).

QUICK RECOVERY FREQUENT. Yet, in both

pauper

and
non-pauper cases,

the after-history discloses the fact that a substantial proportion of the persons apparently insane, from alcohol or otherwise, recover sanity and mental control within a period of from a few days, till from six to ten weeks or thereabouts.

PROBATIONARY CURATIVE DETENTION. Since I first suggested an alterative temporary procedure, the thought has often recurred to me: Why should temporarily mentally unsound inebriates or others have to be declared insane, or (in urgency private cases) sent to an asylum for a time? Is it not practicable, with due regard to the public safety, to the recovery of the mentally diseased themselves, and to the safeguarding of personal liberty, to subject them to compulsory curative treatment for a limited time without certification, or a judicial declaration of insanity, or residence in a lunatic asylum. I have little fault to find with their treatment in

asylums. On the contrary, I have seen too many such cases permanently cured, and know too much of the consideration and conscientious regard for the well-being of the in

mates, to have few words, except of commendation, for asylums and their medical officers. Yet, in view of the widespread prejudice which prevails against the reliability of persons who have been discharged, even though discharged as “cured,” from an asylum, an ungrounded prejudice, often more inveterate than against criminals who have served their time in a prison, and operating seriously among the poor against that resumption of occupation in life which is so essential to sanity and bodily health (an evil considerably alleviated by the excellent work of the “After-Care Association") I cannot but feel that it would be an enormous advantage if some probationary resident treatment could be provided and enforced, prior to certification of lunacy.

CLIMACTERIC MENTAL UNSOUNDNESS. A large proportion of insane cases consist of the functionally unsound of mind, concerning which group there has, since the recent evidence of my friend, Dr. Savage, in a well-known trial (Commissioners of Lunacy vs. Sherrard) that climacteric insanity is not certifiable, been great difference of opinion. Whether ultimately settled to be or not to be certifiable, I have seen many climacteric cases which would probably have proved fatal by suicide, or murder, or accident, which have been cured by residence and treatment in an asylum. In wealthy families, where I have been able to rely on an adequate staff of skilled nurses and attendants for weeks or months, in various functional mental crises, especially of insanity of the menopause, the result has been entirely satisfactory. But for constant watchfulness and efficient nursing, disaster, to say the least, must have occurred. The erewhile patients are now thoroughly restored in mind, filling as intelligently and effectively, as ever before, their domestic, social and other duties.

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