Report of the Royal Commission on the care and control of the feeble-minded, Volume VIII.

  • Great Britain. Royal Commission on the Care and Control of the Feeble-minded.
Date:
1908
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Licence: In copyright

Credit: Report of the Royal Commission on the care and control of the feeble-minded, Volume VIII. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    MENTALLY DEFECTIVE PERSONS AND THE LUNACY COMMISSION. Chapter XXXV. Intermediate Hospitals, Family Colonies and Guardianship, Farm Colonies and Observation Virards. establishment should be made without delay. We regard it, indeed, as very Reception wards important that a free hand should be allowed to committees in dealing with this reception matter so that they may be able to utilise many existing agencies for the purpose, l^ouses— We do not consider it at all necessary that in crowded centres of population, large and expensive buildings should be erected like the reception blocks of the great county asylums. Separate wards in workhouses or in general hospitals might be used under contract, or existing houses or other buildings adapted. The special advantages of these reception wards for the clinical study of mental disease are so evident that many general hospitals, especially those to which medical schools are attached, would be glad, we think, if they were subsidised, to provide them within their own premises, or in neighbouring buildings, with medical, nursing and attendant staff complete. Those of us who visited America were much impressed with what we saw of the work done in reception and observation wards there. (7.) The Temporary’’^ Certijicate. 713. Another similar procedure has also to be considered from this point of view—the certification and treatment of “ unconfirmed ” cases. No statistics are forthcoming in regard to it, but the evidence respecting it is entirely favourable. Dr. Clouston, the Superintendent of the Royal Asylum, Edinburgh, explained to us its origin ;— “ W “ iiave,” he said, “ in the original Lunacy Act in Scotland a clause which comes in the middle of one of the sections which empowers any registered medical man to give a certificate, as we say in Scotland, ‘ on soul and conscience ’—a kind of solemn cer- tificate that his patient is afflicted with a certain disease. You do not require to put anything mental in your certificate at all. You usually put something in reference to mental disturbance, but you do not use any of the technical terms. . . . You say that he labours under some mental disturbance, or that he has certain nervous symptoms, with mental depression : you put that in, but the certificate says that the ^ malady is ‘ not confirmed.’ This is the very gist of the whole thing. You cannot do it in a case you know to be incurable, it must be really for the purpose of cure. ‘ And I consider it expedient with a view to his recovery that he should be placed,’ and we specify the house in which the patient is to be kept, ‘ for a temporary residence, a term not exceeding six months.’ This procedure is used ‘ to a very considerable ex- tent.’” The “temporary certificate ” and the treatment of “ unconfirmed cases.” Clare, Vol. IV., 33733-33734. Clouston, Vol. IV., 30942, 31036. Smith-Whitaker, Vol. IV., p. 237, col. 2. Pennant, Vol. IV., p. 257, col. 2. Tuke, Vol. IV., 28617, 28623. And Dr. Clouston adds :— Clouston Voi iv “ I am not aware that any bad result has ever occurred from its use. The certifi- 30942 ’ ' ’ cate is the more effectual for its purpose—‘ recovery and temporary confinement ’— 30943. because it is not notified to any lunacy authority whatsoever ; in fact it is a private certificate about which no one knows anything.” The patients under it go to private houses only. In England such cases 30944. as are described by Dr. Clouston are frequently admitted to private or nursing homes. Recom- LXVII. Recom. LVII. Recom. XIII. : Preamble (6). Bill to amend the Lunacy Act presented by the Attorney General [Bill 179] 1905. Smith-Whitaker, Vol. IV., 31358. Buist, Vol. IV., 31487-31497. 31501. 31506-31509. 714. A somewhat similar, though amplified, procedure has already been included in the draft of a Lunacy Acts Amendment Bill. The utility of the method, however, lies largely in its simplicity and informality, and in amplifying the regulations, this must be borne in mind. No more than this is necessary, for the certificate, as in the case of the observation ward, is not a certificate for detention, but for temporary residence, cure and treatment. This method is already taking root in England, and by turning it to account the pressure on asylums might, we think, be yet further reduced. We recommend in Recommendation LVII. : That anyone who for profit shall receive to reside as a patient or maintain any person appearing to come within any of the classes of mentally defective persons defined in Recommenda- tion IV. shall within seven days thereafter notify the same to the Board of Control. And, further, under Recommendation XIII. the Board of Control are required to undertake the registration, supervision and inspection of all houses in which two or more mentally defective persons are maintained for private profit, and to visit such houses at least twice a year. (8.) The Promotion of Sdentijic Investigation. 715. Lastly, there is the direct promotion of scientific investigation as leading ultimately, it may be hoped, to yet further preventive measures. Sir James Crichton-Browne, who strongly advocated the establishment of a Ministry promoted, of Public Health as a centre for the promotion of medical science and the super- vision of all departments of sanitary and medical administration, insisted on the necessity of further developments in the study of insanity. Voi*i^v^ ^96^4'^’ “It seems to me,” he said, “to be the important que.stion for the country: . beyond all administrative machinery is this enormous growth of lunatics which is 245