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LAWS RELATING TO PERSONS.

On the Condition of the Insane in Scotland, as influenced by Legislation. By SIR JAMES COXE.

THE

HE extent to which the law interferes in the treatment and management of the insane in Scotland, is in a considerable degree regulated by the circumstances and position of the patient. So long as he remains in his own house, or under the care of his immediate relatives, the law makes no inquiry concerning him, and takes no cognisance of the manner in which he is treated, except in those rare instances in which a complaint has been lodged with the General Board of Lunacy, to the effect that during any part of a period exceeding one year after the appearance and confirmation of his lunacy, the patient had been subjected to coercion or restraint; or in those in which the Board from any cause have had reason to believe that such had been the case. But so seldom is any complaint of this kind made to the Board, and so seldom is there an opportunity of acquiring reliable information concerning insane persons not subject to visitation by the Commissioners, that it may be safely received as a general truth that the law takes no cognisance of any lunatic while resident at home or under the care of relatives, however miserable may be his condition, provided he is not in receipt of parochial relief, or at large and dangerous.

But with the acceptance of parochial aid, the law immediately ceases to be passive, and endeavours to provide a guarantee for the proper application of the parochial funds. With this view it calls for the immediate removal of the patient to an asylum, unless, after due investigation, the Commissioners in Lunacy shall grant their sanction to exemption from such removal, and to the disposal of the patient in some other manner. In this case, however, he remains subject to the control of the Commissioners, who are bound to inform themselves by periodical visitation and inspection that his condition and treatment are satisfactory. But the relatives of any pauper patient may at any time withdraw him from statutory control, by renouncing all claim to parochial assistance, and taking on themselves the burden of his maintenance. In this way the position of a private patient is again acquired, with its immunity from State interference; and so thoroughly is this the case that such patient may even be removed from an asylum, not only without the concurrence of the Board of Lunacy, but against the strongest representations of the medical superintendent of the establishment. How far it is advisable, in the interest of the insane, to accord such powers to their relatives, is a question which is open to much doubt. In their Fifth Annual Report, the Board of Lunacy have expressed an opinion that the removal from an asylum of unrecovered patients, who have been under treatment at the public expense, should be

made dependent on the concurrence of the medical superintendent, to be granted only when probable hopes of recovery, or of special benefit from asylum treatment, can no longer be entertained.

But whenever admitted into an asylum, all patients, whether private or pauper, become subject to Government supervision through the Commissioners in Lunacy, whose duty it is to inquire into and report on their condition and treatment.

It is however evident, that putting aside altogether the welfare of the patients, it may occasionally be the interest or the wish of relatives to detain them at home; and at other times, again, their interest or their wish to place them in an asylum. Much will, of course, depend on the circumstances of the family. Where the pecuniary resources are limited, the cost of maintenance in the asylum is generally avoided as long as possible; and from this cause the patients are too frequently detained at home until their maladies have become chronic, and their chances of recovery have been greatly diminished. This is an evil of very considerable magnitude. It appears from the Fifth Annual Report of the Commissioners in Lunacy, that in the year 1861 there were intimated to them 1,124 pauper lunatics, of whom 995 were at once sent to asylums, and 129 disposed of in private dwellings with the sanction of the Commissioners. But of the 995 who were placed in asylums, a large proportion, but one which, from various causes, it is difficult correctly to estimate, had already been insane for many years; and were now placed under treatment only when, through the failure of their resources or the death of relatives, they had become recipients of parochial relief. But through this delay much injustice is done to the patient, as well as to his parish; to the former by greatly diminishing his chances of recovery, and to the latter, by giving permanence to a burden which under other circumstances might have proved but temporary. In a great measure, the root of this twofold evil lies in the poor law, which does not authorise relief being extended to any one until his own resources, as well as those of such of his relatives as are legally responsible for his maintenance, have been completely exhausted. No distinction is, in this respect, made between sane and insane paupers. Yet such a distinction might very properly be recognised, for it is difficult to suppose that insanity could be feigned for the purpose of obtaining relief; and it is alike cruel and impolitic to reduce the patient and his family to absolute pauperism before admitting their claim to assistance. By enacting that any person labouring under insanity should ipso facto have a right to treatment in an asylum at the public expense, the evil referred to would be avoided; and in this way not only would all pecuniary motives to detain the patient at home be removed, but a positive inducement would be held out to place him at once under treatment. But in order to secure the advantage of early treatment, which general experience has proved to be of the most vital consequence in insanity, the privilege of gratuitous maintenance should be restricted to the period of a year from the commencement of the attack. The primary object which it is sought to attain by the erection of district