open and systematic way. She has no wish to be burdened with too many children; she knows that all idiots will be kept at the expense of the state, so she uses opium, her infallible recipe for artificially producing idiocy. She begins by

giving her infant at a very early age small doses, and gradually increases them, until the development of its mental faculties is safely, surely, and thoroughly arrested, and then hands over the carefully-manufactured idiot to the care of the state. Are English lovers of "Quietness" much more tenderhearted?

WYMA.

ART. VIII.-LUNACY LAW REFORM.

AMONG the innumerable essays and newspaper articles on the subject of lunacy, and asylum arrangements, which have lately appeared, a series of papers in "Social Notes," entitled "Lunacy Law Reform," deserves serious attention. Unlike most of the productions of voluntary critics of this subject, the author of these articles approaches his work in a fair and temperate spirit, untainted by the rabid sensationalism that deprives most productions of the kind of any claim to consideration. His strictures are based on a careful examination of the facts which authorise them, and though it can hardly be said that he displays so intimate an acquaintance with the working of the regulations he condemns, as should be, yet he is obviously careful to criticise only after attentive study of as much as he has been able to acquaint himself with.

The question how far medical men generally are, and should be, specially educated in the science of mental medicine, is one that has engaged frequent attention on the part of professional authorities, and is one moreover on which there will be found a common agreement. That the curricula of the schools are oftentimes deficient in this particular may perhaps be admitted. The power the law gives to a qualified practitioner, by his ipse dixit, to influence the freedom of a patient concerning whom he is called to pronounce an opinion as to mental condition, presupposes a familiarity on his part with the phenomena of insanity, as well in its initial phases as when it has developed with marked characteristic symptoms. The absence of any universal standard of requirement in this respect from examining boards, however, precludes the probability that an attempt will always be made by students either before, or subsequent to, qualification, to ground themselves in the knowledge requisite to give their diagnosis any authoritative weight.

It is true that opportunities are not wanting in this respect; that every medical student can easily obtain permission to investigate practically the appearances and causes of insanity in institutions specially devoted to the treatment of the disease; but it is little to be wondered at that, with the voluminous studies he is compelled to undertake, he but rarely finds time or even inclination to prosecute others in this line. Extension of the period of education will, sooner or later, have to be determined on; and when this has been settled it may be

accepted as certain that nervous diseases will occupy a conspicuous place in the enlarged curriculum. In the scheme of examination of several licensing corporations mental medicine has for some time past found a place, but there is, naturally, a feeling of unwillingness on the part of examiners, however much they may feel the necessity of it, to insist on adequate replies to the questions set in this subject, as a sine qua non of success. The writer in "Social Notes" recognises this difficulty, and points out the anxiety expressed by the various examining bodies on behalf of more extended information. He is in fault, however, in quoting from the "Lancet" of 1865, to the effect that "no instruction whatever is given at any of our London medical schools on the subject of mental disease," with the intention of applying it to the present condition of things. At several schools the importance of training in nervous diseases is prominently recognised. At the Charing Cross Hospital, for instance, there is a special class devoted to the subject, under the care of Dr. L. S. Forbes Winslow; and at the London Hospital the clinical lectures of Dr. Hughlings Jackson are entirely devoted to lesions of the nerve structures. At other schools, too, though perhaps less directly, the subject is daily receiving an increased amount of attention. The defect, however, remains in great part that, as a rule, medical men do not receive that degree of instruction which is demanded both by its importance per se, and by the great discretionary powers invested in physicians, by virtue of the authority given them to decide on the necessity for special treatment in particular cases. As reflecting the opinions common among the most intelligent lay observers, the following passages are worth reproduction from the "Social Notes" contributor's article. It will be apparent from it that he only vaguely appreciates the difficulties surrounding the subject, and that he only in a degree comprehends the resources available for removing them.

He writes that "To become conversant with mental alienation, it is necessary not only to be well-informed upon medicopsychology from books and other publications connected therewith, but clinical lectures on the same should be attended in the wards of lunatic asylums. Now while psychical lectures have been established, insanity is not made a compulsory subject for examination by any of the medical corporations. On the other hand, subjects of comparatively smaller practical value to the great majority of practitioners, as botany and practical chemistry, form a necessary part of the curriculum of medical education. This omission arises from various causes, among which may be mentioned, firstly, the little interest taken in the

study of psychology until very recently; secondly, the great number of subjects upon which medical students are required to read for their examinations, the very limited time allotted to them for this purpose, and the reluctance on such account of the medical examining boards to add to this almost intolerble burden; and, thirdly, the great difficulty of the subject, which can only be appreciably studied by senior students who are well-informed on collateral medical questions, but who are very much engaged in hospital practice when lectures are delivered on mental disease."

This is a fair statement of the problem, but exception may be taken that it is only incomplete after all. The "difficulty of the subject is one associated with preliminary knowledge rather than any other defect. The medico-psychologist requires to be, above all, a skilled physiologist, and only so will he, with the additional assistance received from the practical application of physiological principles in the ward, become at length an alienist with sufficient knowledge to give him weight in his future relations with the mentally unsound.

The beneficial effects produced on patients in asylums by providing them with subjects on which to occupy their minds is adverted to, and it is suggested that methodical educational training should be universally introduced into all asylums for the insane. "Jylox" (the pseudonym under which the papers in "Social Notes" are written), however, seems not to understand the marked distinction between private and public asylums in this country, respecting the facilities given to their inmates for intelligent recreation. While the State-controlled institution possesses all, and only, the characteristics of a prison, conducted with prison-like routine, patients in private houses are always free to amuse themselves after the manner that they desire, so long, of course, as it is a harmless one; and they possess, moreover, the incalculable advantage of liberty, in every case where it can with ordinary safety be permitted to them. There is undoubtedly much to be said in favour of regular employment of an elevating kind, and, when resorted to under adequate precautions, it unquestionably results in good to the patients themselves, and in relief to those charged with their supervision. "Jylox," however, is inclined to judge somewhat sweepingly from the published reports in one or two cases, that the measures he applauds will be universally beneficial. He does not apparently speak as having a practical and extended acquaintance with the working of asylums, and to this extent his reflections are deprived of the importance that would attach to them after personal investigation of that he essays to examine. With this drawback, however, his articles are careful and intelligent: they

profess to deal only with the necessity for reform in the existing laws; but inasmuch as the necessity for reform can be deduced only from a knowledge of present imperfections, there is strong a priori reason why suggestions concerning it should be based on accurate knowledge of the evils consequent on its defects. These evils are freely described and exhaustively criticised' in sensational articles, but since they, as a rule, exist. only in the imagination of the heated opponents of things about which they generally possess only hearsay information, it is not surprising that most of this kind of writing is a mere aggregate of nonsensical absurdities. The public mind, inflamed by the recollection of enormities which-before the era of the Royal Commission on Lunacy, were of undoubted occasional occurrence, is at all times ready and willing to give heed to whatever highly-seasoned descriptions of impossible scenes are presented to it. Hence is it that so much that is criminally libellous finds its way into the columns of newspapers and magazines to the detriment of private asylums. It is, therefore, a matter of congratulation that even one writer from the outside ranks, is conscientious enough to throw aside the prejudices that influence his class as a rule, and in place of wholesale attacks in the dark consents, before hurling his bolts, to inform himself by reading and by inquiry of the things that actually are. We are not surprised either that even after this proceeding, he writes in condemnation of the existing laws. The authorities he cites are such as to show that he has consulted those who, for one reason or another, have presented one, and that the worst, side of the question in their testimony. Dr. Bucknill, than whom hardly a more misleading guide could have been selected, is again and again quoted in support of views in favour of reform. The ill-judged attacks of Dr. Bucknill have been sufficiently refuted ere this, to deprive his dictum of any force, and we can hardly suppose that any one now will be prepared to attach importance to the assertions he makes. The need for reform will make itself sufficiently apparent as it arises, and assurance may be entertained that measures will be taken to secure the changes necessary to effect it. None are more alive to the advantages of improvement than those who are the vanguard of its promoters, the proprietors of private asylums. They know full well how far it is wise to amend, and they progress along the path of advance slowly but surely. The practical alienist recognises the folly and the carelessness of sweeping changes, and he prefers, in the interests of his charge, rather to incur ignorant censure than to do that which would tend to the injury of those committed to his care, however loudly the demand from outside may be echoed. PART I. VOL. VII. NEW SERIES.

G