INCIPIENT MENTAL DISEASES

Otago Daily Times, Issue 14715, 24 December 1909, Page 5

INCIPIENT MENTAL DISEASES

ALLEGEDmDEQUATEPROVISraNS

SOME INSTANCES AND OPINIONS.

What appears to be a matter worthy of tZ A ■ do ' lact " l< ; nt interested is tliutof tho seemingly inadequate pvovisicn mado for the treatment or' cases of ?,. client lunacy For years past there has oxistol a condition of aftairs on whs mcdioal inen have somewhat stromdy animadvorted and which is said to havo been u cause of much anxiety and distress to many unfortunate people. Tho matter is now however, definitely before the Hospital Trustees, who have given indications that they are prepared to handle it, so to speak, with the gloves off. Tho following, Zto ? I? ft" ? J xlTa . ct , f I om a »port submitted to the Hospital Trustees by Dr Falconoi-, tho hoiieo 6urgeon, on Monday speaks for itself:—

_ I beg to.ask tho trustees foe definite instructions in regard to tho question « of admitting unccrtifiablo and incipient' mental patients, who, though they cannot logally ho sent to BcaelilY, nevertheless, owing to potential suicidal tendencies, require constant supervision. Wo have' one such case in the Hospital at present which will cost the trustees 24s a day for supervision by special attendants. Hitherto I have refused to admit such cases, but the bulk of medical and magisterial opinion in tho district has been opposed to this cour.se. The by-law* of the Hospital arc not quit© clear on the point. Tho reasons advanced in favour of admission are:— t 1. That it is a grave scandal that there is no place in the Hospital district to which these patients may be sent. 2. That next to a proper place for their reception being erected, the Dunodin Hospital should serve ns a substitute, inoro especially as the Hospital authorities have agreed to treat one*phase of acute insanity —namely, acute alcoholism. The reasons against admission are:— 1. Tho present wards, and likewise tho proposed D.T. block, are not suitable for tho treatment of, say, borderland coses of melancholia who, though not certifiable as lunatics, nevertheless arc- potentially suicidni. 2. Tho cogt of mental cases nt present is borno by tho consolidated rovonuo, and not by the Hospital Board, though it is quite passible that tho Government may decree that the Hospital Board shall look after uncertifiable mental patients. 3. Legislation would bo necessary. At present patients, such as the one now in the Hospital, may at any time bring an action for damagos for illegal dotontion hero.

4. Tho presence of such patients is a source of constant worry and anxioty to nurses and pationts in tho wards to which thoy are admitted. MEDICAL POINT OF VIEW. '

In order that the position might be properly appreciated, a reporter waited on one of the leading medical practitionors in Dunodin, and asked him to make a statement concerning if. " First of all," said tho doctor, '"in order to seouro tho safety of tho public and prevent people who are not insane from being committed to asylums the law demands that * case of suspected lunacy must first bo reported to the stipendiary magistrate for the district. It is then the lattor's duty to. see whether there is a prima facie case for examination, and if ho is satisfied on that point ho nominates two medical men, who independently oxamine the patient, and furnish a report to tho magistrate. In ordor that the patient may be sent to tho mental hospital it is essential that tho, doctors be satisfied, from observations marie personally, that tho case is actually ono within'tho,meaning of the act. Tho magistrate, having received reports from tho two doctors, examines them, and if ho finds that they bear out the charge of lunacy he commits the patient either to a private or public mental hospital.' Hare the patiiint is again examined by tho montal hospital doctor, and later by tho Inspector of Mental Hospitals, and if all these different people aro satisfied that, the- jxiticnt is really insane ho becomes a lunatic'in'the; eyes <5f tho law "In the great majority of cases tliero is little doubt' about the question of lunacy: the medical man can tell, by certain we.ll-delined signs, whether or not tho patient is afflicted with insanity. But there are many oases where the circumstances of tho examination place both patient and doctor at a disadvantage. The 'doctor is called in for a few minutes to tho police station, or the courthouse, or to some private house, and is asked to pronounce an opinion at once, whereas ho should l;s given an opportunity of watching the patient from day to 'day, and in a large number of cases such careful and frequent observation is necessary before a certificate of insanity can fairly bo given. ' "Under present circumstances tho patient is brought in from the country for examination, but is not readily admitted to hotels or boarding-houses, and there' is not fitting, accommodation at the Hospital. Hie only place there is available, therefore, is tho gaol, or police cells, to which, you cam iimbi-stand, peopc as a general rule . havo a strong objection. There ought to be an observation ward at tho Hospital or at tho Benevolent Asvlum— which is now practically an extension of tlio Hospital. At present, the Hospital olliwafe arc not supposed to admit lunacy cases-apart lioin delirium tremens.-but they frequently do tak'o them in, althou'di thoy have no separate ward for them and no attendants specially qualified to look after them.

. "flic: number of insane in the country iti iii tho proportion of about 1 in every 400 of the ijopulattoii, and this shows how important it is th:tt persons afflicted with this trouble should hi properly attended to, and that provision should bo made for the treatment of insanity in all its stages. I can givo joii a case in point i. was called in recently to see a lunacy patient-a boy who had escaped from an asylum,—and I found him shut up in tho police cells, where ho was kept for a couplo of nights. Ho belonged to a very respectable 'lamily, who keenly felt, the indignity of having to sec their relative shut up in the cells. I suppose (here is nothing in it, in ono sense, hut one can understand how peoplo similarly placed i, „, , l X)sit10 "- 'flic remedy is what IJr Imby King has urgcd-a.ii observation ward for/male and femalo patients, where cases requiring observation may bo placed before being sent to the Mental Hospital. .

men are agreed that it is not fair to the doctor to ask hi m ( 0 givo an opinion as to a man's sanity without an opportunity being jrj von j'f required, of observing him closely 'and carefully. It is not fair to the patient tJiat ho should bo certified as a lunatic after what is sometimes insufficient examination. Very often it happens that a considerable amount of watching is required before the. doctor can be satisfied unit the patient is a lunatic. " All experts are agreed upon this: that in many cases a patient becoints hopelessly itiiane who, had he received proper trea-tmoitt in the incipient stages of his lunacy, might have bcon cured. If the treatment of insanity is applied with a view to euro, it is, of course, bolter to tako tho patient in the early t;fages of his diseaso than after it lias had free sway for a considerable time. Tho trouble is that many jiooplo keep their relatives closely-at home month after month after they show the first sitrim of insanity, until they become quite insane, rather than send them to a mental hospital for treatmeat. They have a horror of the yery

nnme of asylum for some reason, and delay socking the aid of that institution as long as possible. What is wanted; perhaps, is a sort of intermediate institution, between tlto observation ward at the hospital and the asylum, to which persons displaying symptoms cf incipient insanity might be sent ami receive a proper course of treatment. That, howover, is a matter of opinion." POSITION OF POTENTIAL PATIENTS. Seeking to learn the position of the. patient in poor circumstances who, while not exactly insane, or not in that condition, which justifies a medical man giving a certificate, is y 3 t entitled to special treatment, t ic reporter was informed that, it has beer, tin; custom in the past for tlto authorities at biaclitf 10 accept voluntary patients, when the eases were suitablu ones. Kaoh of these- eases has received the speoM attention of those in eharitn, and has bcC given the treatment its nature demanded, these put tents, pi course, were lunatics, but their weakness received the benefit of skill, science, and experience, and the only consideration which in any way influenced the character of their treatment, was the nature of their disease. Another matter to which attention was directed was (ho impossibility of giving uniey cases proper treatment in a general Hospital It was pointed out that ttie right place .for the treatment of menial disease was a mental hospital, and, further, how foolish it was that incipient lunacy should bo permitted to develop because sentimental reasons did not allow the patiest to be sent to an asylum tor treatment. An observation ward was certainly a meat necessity, for reasons already sot forth.

A CASE IN POINT. A case in point was brought uttdor notice on lucsday morning. A respectable working .man from North OUgo had just brought his wife into Dunedin, and waa seeking to havo lier admitted to tlio Hospital. While she was not exactly insane, aha had developed a kind of melanoholia, with suicidul • tendencies, and could nub be left alone. The husband, a middle-aged man in poor circumstances, was, of course, averse to leaving her by herself, yet he could' not afford an attendant and ho had to go to work. His wifo had beou under medical treatment, but tho doctors had refused to certify her insane, arid, as a solution of tho difficulty, had recommended that she be sent to the Dunedin. Hospital. Tho man understood that there was no admission to Soacliff without a certificate, and, under the circumstances, had brought the patient to Duncdin. Tho house surgton pointed out to him that he could not admit the case. He had • no accommodation for 6Ueh pationts in tho Hospital, and no means of giving this patient the particular kind of treatment she required. If she could not obtain admission to a mental hospital, and special treatment in her home was not possible, ho was afraid that nothing could bo done. ."This is tho sixth application of tho sort I have had within a fortnight," said Dr Falconer, "and I havo had to rofuso them all. I can do nothing else. I am helpless."

Summed up, the position seems to bo that while mental asylums provide an excellent, system .for tho ewe and proper caro of cases' of insanity, not sufficient provision is made for cases of lunacy and incipient lunacy not yet within the walls of art asylum. Jji 1&84, the number of insane in' tho country was ono in every 393 persons; in 1906 this lead increased to ono in every 286 persons. Tho toi-al number of patients in tho mental hospitals on the Ist January, 1908, was 3240; by tho 31st December, 1903, this number had increased, to 3999. It is contended that, under the oircumstances, and in view of the number of lunacy patients certified to, every offort should 1)0 made by thos; l responsible to make proper provision for treatment of cases of incipient lunacy and for tho observation of suspected lunatics. No ono would suggest that at the present time a lunatic asylum carries with it the samo menace as. in the day 6 of Charles Kcad'c, yet it is only fair that a doctor, being asked to pronounco a man sane or irsaira should-'bo given every opportunity of closely observing the perron" in qutstioiu DISCUSSION BY THE TRUSTEES. When Dr Falconer's report wa6 .before the Hospital Trustees on Monday evening, The Charman (Mr S. Solomon) said 1 that the problem .vith which they wero faced was not by any means easy of solution. Ho certainly would not attempt to gay what should ho done. It seemed to him. that each .ease should stand on its own looting, and bo treated accordingly. Thedoctor asked for instructions, pointing out that .while these patients had not reached that stage at which they could bo certified and sent to SeacliW, yet they might liavo suicidal tendencies, thus demanding constant attention. They did not havo proper' facilities for the treatment of suoh cases in the Hospital, yet they had been forced to admit a number, which wero, undor the circumstances, a source of very great expense to the trustees. Tho curative treatment required by such patients could .not be supplied at the Hospital, and any period during which thoy remained there could not bo any great henofit to them. Yet what could they do'! They could not turn the poor creatures away from the door..

Mr Gallaway suggested that the-y should hold the matter over for a week or two, and meanwhile the chairman, might talk it over with Mr Widdowson,

A Member: Do you think this subject ofio that wo, as a. moribund board, shouW tackle?

Mr Gallaway said that they should leave tho Hospital affairs in as good order aa possible for the incoming board, and if they could give tho latter a lead in dealing with uncertifiable mental patients they should do so. This was a responsibility cast upon them, and he hoped it would not be shirked.

Tne Cnairman said that thoy had no intention of shirking thoir responsibility, Ho would certainly talk over tho matter with Mr Widdowson and see- what could bo done. ,- Dr Batohelor said ho thought tho matter was one that might best bo dealt with at headquarters. /

The Chairman: But, gentlemen, there is also tho humanitarian sido to bo thought of. If a poor creature cornea hero, in poor circumstances, and in need' of medical or surgical treatment, it will fako a very groat deal,to satisfy mo that w'o are justified in turning him away. I say, take this unfortunato iiorson first, and consider tho financial aspect afterwards.

Mr Callaway: A destitute person of weak intellect has to ohooso between liero and the police colls, and I say send thorn tere every time.

It was Agreed that tlio matter bo held over temporarily, and that in the rmetotlmo the chairman mako inquiries as 'trt what could best bo done- to better tb • position.. '