REVIEW.

New Zealand Herald, Volume XXIV, Issue 8020, 6 August 1887, Page 1 (Supplement)

REVIEW.

LuNAOy in Many Lands. By G. A. Tucker. Sydney: Published by Charles Pofcten, Government Printer. The question of lunacy in New Zealand will force itself upon public attention more and more as years pass by. The present state of things cannot exist much longer. Even the most callous and indifferent will awake from this lethargy to find that they, too, are concerned in the legal qare and treatment of the insane. The tax-gatherer'e hand goes deeply into their pockets for the maintenance of pauper lunatics, but, as the taxes are indirect, thoy do nob realise this fact, or they would be incited even by sordid motives of self-interest to ps,y some attention to lunacy. But probably the day is not far distant when in the interests of civil liberty, if not on the grounds of mercy and humanity, they will be driven to concern themselves on tho subject. It is no secret that: people are being in* oarcerated in our lunatic asylums in violation of constitutional law. The victims at present are friendless, forgotten, or forsaken ; but occasion will arise when some victim will have a friend to not tho law in motion for his defence, and when certifying doctors or committing magistrates have sustained heavy damages, the liberty of the subject will appear to be a little more precious ; they will not bo so ready with a mere dash of the pen to consign men and women to imprisonment in a lunatic asylum. It is certainly a violation of the spirit of our Lunatics Act, 1882, to iucarcerate in our asylums the olass of people who are being sent there now ; and the law of England recognises that where the insane are not dangerous to themselve or others there oan bo no legal justification of their imprisonment in a madhouse. In the case of Nottidgo v. Ripley, which came before the Courts some years ago, tho Lord Chief Baron sustained Mr* Cookburn (now Lord Chief Justice) in his contention that an unjustifiable outrage had been committed on Miss Nottidge by incarcerating her in an asylum, because, though Insane, she was not dangerous to heraelf or others. The jury awarded damages, although they found that tho defendants had not been aotuated by unworthy or mercenary motives. In the suit Flotchor v. Fletohor, whioh was argued ten years afterwards before the Judges of the Queen's Bench, the principle was roaffirmed. Chief Justico Campbell said :— "By the common law of England it iR only a peraoD of uuaound mind, and dungerous to himself or others, that may be restrained of his liberty by another." Justico Wightman, Justico Crornptou, and Jusfcioa Flail ooucurred. These casos are fully detailed by Dr. Buckuill in his work on the care of the Insane and their legal control; but sulliuicnt has beon said to ehow that if some frieud with a few pounds in hia pocket interfered, he could make it unpleasant for thoao who Ret harmless, weak-minded persons imprisoned in a madhouse, Now, no one with a grain of common souse oan read the official report of the Inspector-General In Lunacy (Dr. Macgregor), which was laid before Parliament in May last, without seeing that this pernicious custom has become too rife to bo ondured much longer. Tho accumulation of poor creatures " whoso mental weakness is simply a manifestation of senile decay" is attributed to the following oauß3B :—The desire of local authorities to shunt their burdens on to tha general Government ; the frieudlesßness of many who have grown old without contracting family ties; and the fact thai Govorumont provision "stimulates r.v.ian and solfiah relatives to endeavour to thrust tho care of many who are moroly expensive and troublesome at home upon the hands of tho Stat*)." Hence wo find even little orphan children'sometimes buudled into a lunatic asylum. The following prognant sentence, italicised in tho report, applies to young and old: — "Theso poople havo always, more or less, mental woakness, often juNt enough to unable the dnutor- , to fiitfii oertiticates, and they are very troublesome to nurse." Henco they are ijuietiy shunted iuto asylums.

According to Dr. Tucker, the methods of admission are unsatisfactory nearly everywhere. In soma places only one medical certificate) is required, in others none, aud actually in some places nil that is required to got One into a lunatic asylum is a note to the police. What a apleudid chance for disposing of a jilted lover or a troubloeotne creditor ! In Ireland no grounds »re givon in the dootora' certificates for aßsumiug the insanity of the individual. These easy facilities for getting persons into asylums are very apt to bo abused by designing indii viduala, and, therefore, care must be taken to protect civil liberty. Certainly modlcal certificates are not always guarantees of one's insanity. Dr. Maogregor found two sane men in the Wellington Asylum last year, but they had been certified to. The author says:—"Recent disclosures have painfully shown that the duality of certificates is no guarantee that two independent medical opinions are formed as to the condition of the supposed lunatic, and further securities are required a,;ain»t tho contingency of one of the certifying doctors being in any way unduly influenced by tho other. Dr. Tucker contends for a provision by which the dootors should examine the suppoood lunatic separately, report indepen» dently (as is done here), and that it should bo a misdemeanour to interchange opinions on the case. This, however, ie a case where doctors differ, because Dr. Bucknill, an acknowledged eminent authority on lunacy, thinks that separate certifying is " a strange embodiment of jealousy aud distrust; for in other instances, where the opinions of two or more medical men are required, the opposite course is taken in order to sneure the groat advantage of combined observation. When medical men examine a patient together they usually check each other, and are of the greatest mutual assistance in observing correctly. ... If the lunacy laws had not been imbued, with distrust of the medical profession they would never have'contained an enactment abrogating all the advantages of medical consultation. Mather would they have enacted that the examination should be a joint one, the opinion concurrent, and the report thereof, or certificate, mutual." But Dr. Tucker suggests "permitting "medioal certificates of sanity, with a view to neutralising certificate of insanity." This would be gome safeguard, considering, as he points out, that " it ie possible to consign a person to a lunatic asylum if two out of 20,000 doctors (in England) can be found to certify to insanity, even though any number of other \ medical men may have refused to certify, or could be found to do so " This allows that asylum management and lunacy laws are questions which doctors, taxpayers, legislators, philanthropists, journalists, and the general public must never lose sight of, especially as we learnt by the last mail, a few days ago, that at Ward's Island, New York, lunatics were discovered to be "treated worse than madmen were troated a century ago," owing to tho neglect of the board of managers. There can be no excuse for ignorance now. Our daily journals have agaiu and again devoted considerable space to the question of lunacy, and several valuable Government reports and more pretentious works have recently been issued from the Frees. This work of Dr. Tucker's is as valuable an it is voluminous. It contains 1564 closely* printed pages in 4 So size, and is illustrated with diagrams of buildings and plates showing different methods of restraint. The work evinces much painstaking research, and was undertaken as a labour of love, without any charge upon the State, in the same spirit as Dr. Laishley prosecuted his inquiries on behalf of our own Government into tho different educational systems throughout the world. Convinced of the value of Dr. Tucker's researches, hie Government ordered hie work to be printed. It is valuable aa a work of reference, although some of the statistics might have been brought down to a later date ; and there is an immense amount ot very interesting matter for general readers. : The book should be found in all our lending libraries and on the

shelves of legislators and those who take interest in local adminiitration. Dootors also will find it useful, inaemnoh as it contains accounts of treatment of lunafcica In all parta of tho world.

After continuous oversight of the insane for uearly a quarter of a century, Dr. Tucker resolved to take a long respite from professional toil, and he thought he could be of Home cervicn to the cause of humanity by collecting from the leading institutions of the world all that relstes to the treatment of the insane. Armed with a letter of introduction by Sir John Roberteon, Colonial Seoretary of New South Wales, bespeaking on behalf of his Government kind' attention to Dr. Tucker, the latter gentleman set off on his mission In 1882. Ha visited the four quarters of the world, travelling 140,000 miles, inspecting 400 asylums, and obtaining reports from 100 others. The great respect shown to the New South Wales Government was proved by Dr. Tucker's kind reception in all parts of the world ; and on hia return to Sydney he was welcomed back at a complimentary luncheon, when Sir Henry Parkes congratulated Dr. Tucker on his having " done pre-eminent service to the country" by his valuable compilation. In a work of such magnitude it could scarcely be expected that all the statistics are down to date, but it is a little surprising that those relating to New Zealand, a sister colony, in close proximity to Ne« South Wales, are as old a« 1881. Immense changes have taken place since the late Dr. ttkae furnished hia report in 1881, which Dr. Tuoker h»s embodied in his book. The Lunatics Act of 1868 and local Acts have beon repealed and superseded by tho con> aolidated Act of 1S82; the Ashburu fla'l private asylum (tho very beat aeyluir in the oolony) has been opened ; the Soaclifl Asylum at Dunedin has been completed and occupied by 472 lunatics ; the statistics ol insanity have greatly increased; and undei Dr. Macgregor's regime immense Improve mentis have taken place. In IS3I we hac only 1125 lunatics confined in oeyluina, bui at present we have no lema than 1625, ar inorease of 500 ! In our Whaa Aaylam w< then had only 273 patients, but now w< have 378 ! Dr. Tuoker'a report of our loca asylum is anything but complimentary, anc his remarks on the "want of order, oloa'nli. ness, and discipline" do not apply to-day, After inspecting our asylum ho wrote : —"] was not shown tho back parts of the aayluir nor any of tho airing courts, but I canno* eay much for tho good order or oleanlineai of the parts I did seo. The dirty conditiot of the beda would lead one to suppose tha* a large number of the patients are of th< dirty class, but probably the overcrowded state of the asylum is a chief cause. Som< of the single rooms gave evidence of want o care and attention on the part of tho atten (hints. . . . Little uotioc appears to b<

taken of superior officers" (page 675). Again, on page 676, he concludes thus : — " Kemarke : Want of good order, cleanliness, and discipline, in part perhaps due to the overcrowded etate of the asylum." Read in the light of reoent events, these nnbiaeaed remarks of a foreign expert are deeply interesting, and will help the public to realise the herculean tank which Dr. Crcmoniul, tho present superintendent, had to aohieve to carry out needed reforms in spite of organised opposition. It tnußt be gratifying to know that our asylum ia now comparatively a model of oleanlineas, order, and discipline; and when tho now wing of the building in conreo of construction ia completed, better classification will be possible, and greater improvements obtainable. Dr. Tucker'e inquiries have convinced him that very little ia being done in asylums to carefully study montal diseases and treat thorn on scientific principles; and he considers it necessary that aayluma should be roatricted to 300 patients each, provided with competent medical staffs, " to be occupied only with medical duties and in tho necessary research calculated to obtain a knowledge of the diseases they profess to cure." This very point has been urged ogain and again in the columns of the Hkhald, and it has been shown that if Dr. Cremonini, or any other medical superintendent;, is occupied with numerous duties pertaining more properly to a houso-steward, he cauuut possibly have time or strength left to atudy the problem of insanity. Tho writer shows that the proportion of euros is greater in those places where moral and hygenic meaas are alone relied on than in those places where restraints are used. Some remarkable instances are given of tho beneficial effects of abolishing methods of restraint In asylums. In cases where men and women had beon caged, chained, and treated like wild animals, their fetters being takon off, they soon exchauged the ferocity of demoniacs for the gentlenea;) of ordinary mortals. From a perusal of the work it it. evident that whenever restraint or force is reaotted to the lunatics oppose forco by force, and are all but unmanageable. Dr. Cremonini has proved in our own asylum tho great calming effects of freedom and aioral suasion. Sometimes poor, unfortuu?»te men have boon taken to him bound hand anil foot till the corda wnre all but cutting into the fleah of tho sufferers, who were furious with excitement. In spits of the warnings of constables and relatives ho b.as had the patients unloosed, and in a comparatively short time th&y have become α-tln?. and quiet. According to Dr. Tucker, tins system now vnry gonerally prevails, and if 'the author of " Hard Cash" were to visit lunatic asylums now he woaid not find them to be the places of horror which once the,y were. Some of the methods of restraint practiced at Lisbon aud other- parts of Europe are still very sovere, but generally a milder rule prevails throughout aaylamdom.. Dr. Tacker claims that " tho insane have a right to be treated like other human beings," and thinks that enforced baths, irritating, vexatious, and unuoceseary restrictions are not only injurious, but proofs of incompetence and indolonce on part of the management. Even in the criminal asylums of England and America mechanical restraints havo been dispensed with, and employment, pleasant surroundings, amusements, and greater liberty of action ftre the leading principles adopted. The emphatic testimony of Dr. Tucker to tho good effects of these things should encourage our local asylum oommittee to prosecute its good work. In our yriuonlike aeyluni at the Whau there are many bare walls to be beautified with pictures, many tables to be covered with books, papers, s,nd flowers; and now that the Auckland Press has so generously advocated the requirements of the poor inmates, there id hope of those things being prooured,

The author is of opinion that at least one lady modical officer should be in the female wards of every asylum and a female nurse in each male ward. Tiiis question was fully diecuysed at a conference of charities held at Chicago, and possibly at some other time we may allude to it again. £ulfioo it now to say "that at present thousands of female patients are confined, and many livo and die in those institutions who receive no medical treatment (for obvious reasons), where young medical men are alone charged with their care." Dr. Tucker thinks that "the form of insanity has undergone a marked change during the last few years ; that the maniacal form is lose frequent, and that melancholia has increased." Also, that "insanity is largely on tho inorease in every oountry." The last page of the book contains some vory practical lessons which we shall do well to lay to heart in the management of our own asylums. "It will be found on searching the various tables supplied in this work that asylums containing over 300 or 400 pationta a:e more expensive ia their maintenance than thoap under that number ; that the returns of cures in asylums containing over 400 patients are less than in thosa of a less number of patients." No pereon with a grain of sympathy can turn from the pages of this interesting bookwithout admiration of Dr. Tucker's industry, and a feeliug of sadness that such a fearful amount of misery Is concentrated in the 400 asylums, which he visited. Whatever the causes be, whether intemperance, poverty, excesses, or grief, tho affliction ia the most awful that can befall mankind, and all can sincerely axolaim : " O let me not be mid, sweet Heaven ! Keep me lu temper; 1 would not be nnd!" —F. G. EwiHGTON.