A Paper

Read Before the New Zealand Branch of the British Medical Association, at Wellington, on March 18th, 1898.

It may seem strange to you that one who is not a specialist should ask you to listen to a paper on "Suggestions for the Reform of the Lunacy Laws with special reference to the nomenclature used and the present methods of procedure under the Act," hut I take it that we are here gathered together at our annual meeting to discuss any subjects which may be of interest to the profession and to the community generally, and it matters not whether the subject for discussion be introduced by a specialist or a general practitioner. Should I touch on subjects connected with lunacy, which seem to go beyond what is suggested by the heading on the Order Paper, I hope you will forgive me.

Three different facts have decided me to ask the Medical profession to take a keener interest at the present time in those of our fellow creatures who are the subjects of mental disease.

I. Dr. MacGregor's report of 1897, in which he says, "I have so often called the attention of Parliament and the Government to the terrible condition into which all our Asylums, especially Wellington, have been allowed to lapse, owing to overcrowding, that nothing more can be done or said by me. I can only express my earnest hope that orders will be given to finish Porirua Asylum as soon as possible. We shall be fortunate indeed if some calamity or scandal does not occur to horrify the whole country." Later on, he says, "A suitable refuge and school for idiots and imbesiles is urgently needed, to enable us to rid the other Asylums of those poor creatures, whose presence is a great hindrance to the comfort of all the patients, and especially to the recovery of sensitive, curable, and convalescent cases." I did not think that we ought to let this session pass without taking some notice of these remarks of Dr. MacGregor's.

2. The fact that we often see some mention in the newspapers of the overcrowding of the Asylums. This reference in the newspapers had undoubtedly caused a feeling of unrest in the minds of the people, and it is only the knowledge which they possess that the Asylums are admirably looked after by the Inspector of Asylums and his very capable medical superintendents which has prevented the feeling of unrest from breaking out into an outcry for reform.

3. During the last three months, when on a visit to Dunedin connected with University examination business, I happened to visit Seacliff Asylum. I was shown into the large hall where I saw a very large number, it seemed to me to be hundreds, of patients suffering, I concluded, from various different forms of mental disease. They were all seated together side by side. There were a number of long tables; each table seemed to be full. I could not help feeling that such a condition of things must be wrong—there were the possible durables and the uncurables all mixed up together. I asked myself the question, How can a possible curable case recover under such a condition of things?

In this age of scientific precision the time has come to do away from our nomenclature the terms "Lunatic," "Lunacy," and "Lunatic Asylum." They have to us no scientific meaning. A patient suffering from mental disease should be spoken of as suffering from such and such disease, and our Asylums should be called Hospitals for the treatment of mental diseases or Hospitals for the treatment of diseases of the brain. We have our Hospitals for diseases of women, our Hospitals for nervous diseases, for diseases of the eye, throat, etc. Why should we not have our Hospitals for mental diseases? Surely it would be far better to call our Asylum, the Mount View Hospital for the treatment of mental diseases.

When a person is called a lunatic and sent to an Asylum, there is a certain stigma attaches to him even when he recovers; it is harder for him to obtain employment, and he is handicapped in the struggle for existence. Not only is he injured in the sight of his fellow-citizens, but he is apt to lose his self-reliance and his self-control. Moreover, there is a feeling of dislike, even dread, in the minds of the public towards sending any person to the Asylum. Relations and friends will do all in their power to keep the patients away until the disease assumes such proportions that eventually they are compelled to have them committed. If the Asylums were called Hospitals and the inmates were looked upon as patients suffering from some particular form of brain disease eventually the feeling of dis- page 5 like and dread would pass off and patients would be submitted for treatment at a much earlier phase of the disease, when a curative result would more likely be obtained. Moreover to the patients themselves there would be no consciousness of having been dubbed a lunatic no thought of having been confined in a lunatic asylum. Nothing more than the knowledge that they had been in a special hospital for disease of the brain. When cured they simply leave the hospital.

Now with regard to the treatment of patients suffering from mental disease when it is notified to the authorities that such person is suffering from mental disease. The procedure is this: Someone, usually a friend or relative, notifies to the police that such person is a lunatic, the police notify the S.M. who visits the patient at his home and then directs that he be visited by two medical men who examine the patient and send in their report to the S.M. On the medical certificates the patient is committed. To this there can be no objection. But it has often happened to me, and I daresay to you all, that on returning home after the morning or afternoon round of visits to find a notice that you are requested to visit a patient suffering from mental disease at the Police Station; you go at once and there you find your patient who has perhaps been waiting there for hours. Gentlemen, I maintain tain that this is not right. If he cannot be visited at his own home he ought to be taken to some less public place than the Police Station. Why should he not be taken to the Hospital, there to be looked after and cared for until such time that he has been examined by two medical men. Surely such a method of procedure would have a less injurious effect on the patient and be more humane than that he should be taken by a constable to the most public place in the city.

Sections 5, 6, 19, and 25; and "Hospital for Mental Diseases Act Amendment Act, 1891," Section 2.

Certificate that a Person is Lunatie Suffering from Mental Disease, and a proper Person to be detained under Care and Treatment.

I, the undersigned, being a Medical Practitioner in actual practice, hereby certify that I, on the____day of____, one thousand eight hundred and ninety- page 6 at^*____separately from any other Medical Practitioner, personally examined____, of^†____, and that the said____is a lunatie suffering from, such and such form of mental disease within the meaning of this Act, and a proper person to be taken charge of and detained under care and treatment, and that I have formed this opinion upon the following grounds, viz.:—

1.	Facts indicating lunaey mental disease observed by myself.‡
2.	Other facts (if any) indicating lunaey mental disease communicated to others.§

________

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