increase of expense for the insane. This class is increasing relatively not only faster than population, but also faster than either of the other dependent classes. The support of the insane is becoming really burdensome in every State, and is likely to become more and more so every year. A careful review of the provisions made for the insane show that much of this expenditure has been needless and extravagant, particularly in the construction of buildings. The opinion, moreover, seems to be pretty well established, that the present management of our lunatic hospitals and the treatment of the insane are, in many respects, far behind those in Great Britain. This is the testimony of foreign alienists who have visited our institutions, and are capable of making comparisons. It is very evident that some improvements or reforms are greatly needed among us. Are these likely to come from experts in one thing, from leading officers of our institutions, or from members of Legislatures constantly changing? Do we not need men of large and diversified experience, of special fitness and qualifications for such business; men who can devote time, labor and thought to the work; in other words, a good Lunacy Commission?

Again it is obvious, after all, that the advantages growing out of such a Commission must depend almost wholly upon the character of the persons constituting it. It must be composed of men thoroughly acquainted with these matters, men heartily interested in the work, men who have the confidence of the public, and are not afraid of reform. The community, as well as the cause itself, . demand something more than the mere name of a Board or Commission of Lunacy.

Such is the interest and intelligence accumulating on this subject that no well-informed people will always rest satisfied with the present order of things, nor remain content, unless executive and legislative bodies take some advanced steps for improvement in this direction. How much better is it for the hospitals, and all parties concerned, that this interest and intelligence should be wisely directed, and result in some permanent good, rather than that it should be wasted in excitement, in sensational reports, in exposures, and attacks on the hospitals?

Superintendents and trustees, in their reports and through other channels, complain that this fault-finding and prejudice against them and the hospitals are very annoying, and when the complaints become somewhat bitter and personal, they feel as though they

were abused and insulted. But who is to blame? Are there no causes or reasons for it? When it is considered that a large number of persons are deprived of their rights, without adequate means of protection, are confined in close quarters, not accessible to their friends, where it is understood abuses and wrongs are sometimes perpetrated, so reported by the press and individuals that have experienced them, is it strange that the friends of the insane should express uneasiness and anxiety, and that the community should join with them in sympathy and complaint? One of the special duties of the English Lunacy Commission is to exercise a careful oversight of the hospitals, with reference to abuses, wrongs, accidents, etc., preventing and correcting them as far as possible, and making reports upon them whenever they occur. This course satisfies the demands of the public and creates confidence in these establishments.

The fourth party interested is the future, or humanity itself, aspiring to a broader and higher civilization. Its aim is equal rights. Its practical application is the "Golden Rule." Its design is to do the largest amount of good to enlist the best possible agencies. We have here a great evil, insanity, constantly increasing, occasioning immense expense and an untold amount of suffering. This evil is the result of violated law, physical and mental; it is abnormal, no part of a true, healthy civilization. To check the evil, its causes must be better understood, the public must be instructed and enlightened on the subject. As prevention is better than cure, it is our duty to do something in this direction. It is not wise to build great establishments, and make large appropriations for carrying them on, without doing something to remove the causes which necessitate such measures.

Within a few years great advances have been made in a better understanding of the causes of disease and the laws of health. Special pains have been taken by means of boards of health, books, journals, lectures, etc., to diffuse a knowledge of hygiene and sanitary agencies. The fact is fully established that, by a proper application of these means, one-third of the sickness and premature mortality may be prevented. But how is it with insanity? What have hospitals and Legislatures done to prevent it? If a very small portion of the means now employed in the construction of buildings and the support of the insane were expended in different ways to prevent insanity, in removing the causes of it, what

a vast difference it would make in the expense, what in the amount of suffering!

It should be the settled policy of all legislative bodies and the executive officers of every State to carry on some systematic measures of this kind, and unless such provision is made by legislative action, the work will certainly not be done at present. While there is need of improvements in the management of hospitals and in the better treatment of the insane, something should be done at the same time to prevent the increase of this great evil. The claims of humanity and economy demand it. And in no other way, and by no other means, can these objects be so well secured as by the establishment of a good Lunacy Commission.

During the reading of Dr. Shaw's and Dr. Seguin's papers, Dr. H. B. Wilbur, of Syracuse, New York, was invited to the chair, and, before introducing the latter, spoke as follows:

Dr. WILBUR: Dr. Seguin will now read a paper written by himself. I should mention, perhaps, that the Doctor is one of the consulting physicians of the Hudson River Hospital, of New York, and appears as a delegate from that institution.

Dr. SEGUIN: This paper, ladies and gentlemen, is upon the comparatively new subject of the Right of the Insane to Liberty, treating it from a somewhat different standpoint from that taken by Dr. Shaw.

THE RIGHT OF THE INSANE TO LIBERTY.

BY E. C. SEGUIN, M. D., OF NEW YORK.

"The true principle to guide our practice should be this, that no one, sane or insane, should ever be entirely deprived of his liberty, unless for his own protection or for the protection of society." HENRY MAUDSLEY.

It is fair to say that in the present state of psychiatry in America, to be pronounced insane by physicians, by a judge, or by a jury, means imprisonment for months, for years, or for life. To put it in another way, there is a disease which reduces its victims to a level with persons accused of crime, and exposes them to loss of liberty, property and happiness.

Is this just? Is this worthy of a country like ours, which aims to be foremost in works of philanthropy, and preeminent as regards individual liberty?

Let us review the facts of medico-legal practice in the State of New York, on which these statements rest.

1. A man has acute mania, he becomes unmanageable at home, is dangerous to himself and to others. This man is summarily placed in a carriage, taken to an asylum and locked in, without any process of law. Before a certain time has elapsed after his reception (five days), certificates duly executed before a judge of a court of record must be furnished to the superintendent of the asylum as a justification for further detention.

Viewed without prejudice, this course seems the only one which can be pursued, and consequently we deem it right. For to wait many hours or several days for all the legal forms of commitment to be executed, might endanger the life of the patient or of those about him. Still it must be remembered that such cases of very severe acute mania are rare. In most cases a delay of twenty-four hours can do no harm.

2. The same patient recovers in greater part; he becomes quiet, and, with the exception of an occasional false notion and a degree of mental enfeeblement, is like most well men. Yet by virtue of the power of the original commitment this man is kept confined to the asylum, he is yet a prisoner. If he wishes to walk, or to breathe fresh air, or to attempt some little outdoor work, doors must be unlocked to let him pass, and when he returns to his

And this stage of
The sole power of

room or ward he is locked in for the night. partial recovery may last almost indefinitely. discharge rests in the judgment and hands of a single man, the superintendent; the patient is practically under a most singular form of tyranny for any enlightened state to permit to flourish.

No matter how scientific or how good a man the superintendent may be, I hold that this degree of authority, of uncontrolled authority over the liberty of citizens, ought not to be allowed.

3. The same sort of a case, i. e., one of acute mania, terminates unfavorably. The delirium is transformed into a group of more or less fixed delusions, kept up by hallucinations; the memory and judgment are fatally impaired,-in other words, secondary dementia is established. If, as in innumerable cases now in asylums, the delusions of the patient are not delusions of persecution, or of any other form likely to lead to an outbreak of violence or destructiveness, is it right to keep this patient in the more or less costly and elegant prisons we call asylums?

Why should not these remains of a man enjoy freedom under a certain supervision? Why should he not be allowed to go and come as he pleases and to have what little pleasure there remains for him in life?

Let us make a further supposition, which is perfectly in accord with cases daily observed. If this harmless dement has property of his own, why should not this property be used to provide him with a suitable mode of life, and expended in reasonable amount for his benefit? There is good reason to believe that many such patients are kept in asylums, private or public, indefinitely, unprovided with the luxuries or quasi-luxuries to which they are entitled. After a few years of patience on the part of the relatives, and of more or less conscious misery on the part of the patient, the disease ends in death, and the carefully preserved property of the deceased is duly apportioned among heirs.

4. A woman drifts through domestic trouble, semi-starvation, into a state of cerebral mal-nutrition and anæmia; delusions of a melancholic type appear, together with a depression and sadness which cannot be reacted against.

Is it right to imprison such a woman, to place her actually under lock and key for months?

In some cases I am willing to admit that it is justifiable, but in the majority of cases I believe that such a procedure is unjust,