1758 THE TREATMENT OF INCIPIENT INSANITY.

The Treatment of IncipientInsanity.

THE LANCET.

LONDON : SAl URDA Y, DECEMBER 12, 1908.

IN an address recently delivered before the ForfarshirE

Medical Association Dr. A. R. URQUHART made certain sug.

gestions for bridging or avoiding the gap which is so often

apparent between an insane patient’s home and the asylum.He referred to the work that had been done in Glasgow inthis connexion. There the fact that a person is mentallyaffiicted is reported to the medical man who visits and dealswith him in a systematic manner. It is plain that it is not

necessary to remove every person so afflicted from his home,even though he be certifiably insane, and if it be desirable

to remove him from his home it is by no means invariablydesirable to place him in an asylum, and for such cases provi-sion is made in the Eastern District Hospital where the

patients are placed under observation, care, and treatment

until recovery takes place or removal to an asylum becomes

imperative. Dr. URQUHART suggested that at Dundee,where he was delivering his address, two small wards

with 30 beds would be sufficient. The name of such

wards was a matter of considerable importance and

such terms as "mad wards" or "asylum wards" couldnot be permitted. Dr. URQUHART laid much stress on

the necessity of regarding insanity as an affair of

medicine and he urged his audience not to be diverted

from the path of correct treatment or to be obstructed

therein by the law. The law imposed upon them a primaryconsideration of conduct, while medicine imposed uponthem the recognition and investigation of disease and theendeavour to remedy or to assuage its ravages. Their plainduty was the recovery of the curable, the care of the

incurable, and the after-care of the convalescent. Professor

MACEwAN also addressed the meeting and pointing outthat it was one of the most noticeable features of modern

medicine that it endeavoured to deal with cases of disease

from their earliest beginnings, so as to make some impres-sions before the patients became incurable, stated that in

insanity the patients did not get any treatment until theyhad become insane, that is, until they could be certified fordetention in an asylum. He argued that cases of incipientinsanity should be treated in a general hospital and his idealwould be that there should be a department in the hospitalfor nervous diseases and that the term insanity should

disappear.In these columns we have from time to time advocated

similar schemes and in the report of the Commission uponthe Feeble-minded provision to meet such requirements is

urged upon the nation. There is without doubt a largeclass of unfortunate mental patients for whom the pro-

fession, the charitable public, and the State have failed tomake sufficient provision. Too often the medical man,

able to recognise insanity when it has become certifiable,

fails, from lack of special knowledge, to regard as

serious certain symptoms which are, in fact, the preludeto mental breakdown or, recognising them, is at his

wits’ end to know what to do or where to place his patientsbefore the moment arrives when certification is no longer to

- be avoided. So also have the charitable public failed to

recognise that the insane person is a sick person and that

his illness is one that can often be successfully treated iftreatment is commenced early and that the longer treatmentis postponed the less good can it effect. It is as if the public

,

should think that a patient cannot have a pulmonary tuber.,

culosis until he has had a haemoptysis. To the alienist

the most heartrending experience is to note the neglectof treatment at that stage of the disease when completerestoration to health is still possible and the slow declensionof the mental faculties which he knows must eventuate in

such an outbreak that even the public must recognise thatdisease is present. That the State has to a certain extent

been responsible for this unfortunate state of affairs is

obvious. In its desire to bring every mental patient underits cognisance it has created a dislike for the publicity ofcertification, which only induces the friends of patients totake them to the alienist when certification has become

absolutely necessary; it has erected a barrier between themedical man and his mental patient which can only bebroken down by certification or by the ignoring of the lawon the part of the medical man, and it has induced a generalimpression that an asylum is a species of prison to which

persons must go against their will, in which they are " cos-

fined," and from which they sometimes "escape, and to

which, if "ca;ught," they can be taken back by theconstable.

It is pleasing to reflect that this heavy wastage of the

mentally sick to the ranks of the certified insane, which isto a large and as we believe to a hitherto unsuspectedextent preventable, is to be combated in London by thebeneficence of a distinguished alienist, Dr. H. MAUDSLEY.We trust that his scheme may before long be realised. We

cannot, however, but regret that the projected hospital formental diseases cannot be coupled, to some extent, with a

hospital for nervous diseases. One of our hospitals for

diseases of the nervous system is shortly to be rebuilt

on a large scale and is possibly to be provided withaccommodation for so-called "borderland" " cases and

this would seem to afford an opportunity of considering thedesirability and the feasibility of establishing such a

relationship. That in the out-patient departments of

our hospitals for nervous diseases many cases are to be met.with which are, in fact, mental cases is a well-recognisedfact, and it is in those departments that is most acutelyfelt the problem of what to do for the accommodation of

the unfortunate sufferers.

The Progress of the Housing andTown Planning Bill.

IN spite of, or it may be because of, the small attendanceat some of the meetings of the Standing Committee ofthe House of Commons which has been considering theHousing and Town Planning Bill, the labours of the (Jam-mittee are now completed. Clause 13, which amends the