The supply of water, the Commissioners direct, should be equal to forty gallons per patient. It is essential that the water should be of good quality, and attention should be given to a due supply of hot water for bathing purposes; this alone will require forty gallons to each patient per week, but most English baths are capable of holding too much, and would require sixty to eighty gallons.

The construction of the water-closets and drains is another matter which requires especial attention.

In finding occupation and amusement for the patients, the physician must be able to select that which is most suitable for each class and each individual. Here his own accomplishments will greatly assist him. If he has a mechanical turn, and can converse with practical knowledge on the work done, or show various improvements in different industrial arts, he will the more readily attract the workman to himself. The working patient will work with all the greater interest. So if he is able to talk on the subject of stock or cattle, the agriculturist will serve him with the greater zest, and the occupation will be of the greater use to the patient. If the physician is musical, and can appreciate the skill of the musician, if he can enter into the spirit of the game of cricket, play his game of billiards, give his reading from Shakespeare, or if he can, on the other hand, estimate the fineness of millinery, the cost per ell of a new dress, understand the art of crochet, or play a game at croquet, he may bring all his accomplishments to bear as means of cure.

The asylum must therefore be supplied with varied means of occupation and amusement, according to the class of patients; the building must be supplied with workshops and entertainment rooms; as ball room, billiard room, reading room : the grounds with ponds and gardens; the courts with bowling greens, racket court, croquet lawn, &c.

Lastly, the number of patients that should be treated in one asylum is a question of great moment as regards efficiency on one hand, and economy on the other. It is essential that the whole should be under one superintendent; the mind of a man admits of no division; the capacity of one man to exercise efficient supervision must limit the number of patients; and I think no asylum should contain more than 500 patients, of whom at least 400 should be in the chronic stage.

The greatest

Diet. On this subject little need be said. unanimity appears to prevail on the question, that a generous diet is absolutely essential for the treatment of the insane. It was shown by Dr. Thurnam that the mortality was affected by the scale of the dietary. He found that in all those asylums in which the diet was liberal, the mortality was lower than in those in which a poorer diet existed.

The diet must be abundant, nutritious, and well cooked; the quantity and kind of course will vary according to the previous habits of the patient. As a general rule there should be a due allowance of fermented liquors.

A custom exists in most asylums of supplying patients with tobacco; I think this is to be deprecated; at the most it should only be given to those who on admission have been habituated to its use, and then I would advise a gradual withdrawal of it. Patients should be cured of bad habits, and not initiated into new extravagances and vices. I found that women had learnt the habit of snufftaking in the asylum at Hanwell; this was clearly an oversight, which I gradually rectified. When men who have been accustomed to smoke enter the asylum, they should be allowed a less quantity than they have been in the habit of using, and that quantity should be gradually diminished,

LECTURE XIII.

Argument. The legal relations of insanity-The imposition of restraintMedical certificates; essentials to be observed in signing them-The law relating to the reception of lunatics into asylums, public and private, or into private houses—The supervision of asylums, and checks against illegal detention-The mode prescribed to prevent cruelty or neglect of the insaneLunatics by inquisition-The guardianship of the Lord Chancellor over all insane persons; and especially over their property-The plea of insanity in civil and in criminal cases-The mode by which the insanity of an individual is to be determined, or recapitulation of the different forms in which mental disease is met with-Conclusion.

DURING the practice of your profession you may be called upon to pronounce an opinion on the sanity or insanity of an individual, and your opinion may be required, not only for purely medical purposes, but also for legal.

I will therefore to-day describe the legal relations of the insane, and the duties which may be imposed on you as medical practitioners in relation to the care of the lunatic.

The chief legal grounds on which your opinion may be sought may be thus classified:

1. For what is technically called the Imposition of Restraint. The restraint may be either on the individual's person solely, or on his person and property.

2. To relieve the individual from the responsibility of his

acts.

Firstly, then, with respect to the imposition of restraint. It is provided by the law that no one shall be deprived of his liberty on the grounds of his insanity-on the ground rather that he is dangerous, either to himself or others on account of his insanity, without, firstly (in the case of paupers), one medical certificate and an order signed by (a) a justice of the peace, or in his absence (b) an officiating clergyman and the relieving officer or overseer of the parish in which the lunatic is at the

time; and, secondly (in the case of non-paupers), the medical certificates of two legally qualified practitioners and the request of a relation or friend.*

With respect to the medical certificates, there are three things to be specially remembered, and which may be called the essentials of the certificate.

1st. The medical certificate will remain valid for seven days only, and the date of the examination and the date of signature must be distinctly given.

2nd. When two medical certificates are required each medical man must examine the patient separately, and neither must be at all interested, directly or indirectly, in the patient or the establishment to which the patient is to be sent.

3rd. The certificate must set forth the grounds of the medical practitioner's opinions, "as observed by himself" (sec. 75).

These are the essentials, and if they are not all attended to, the certificate will be invalid, and the superintendent of an asylum will be obliged to refuse admission to the patient.

There are other matters which may be called non-essentials, but which require your attention. These would not invalidate the order. All that I need say on this point is that the printed forms of order, which may be bought of the law stationers,† must be carefully filled up according to the marginal directions, and with attention to them you can scarcely err. Should an error on these non-essential points be found to exist, however, the patient may be received and the certificate amended (sec. 11, cap. 96; sec. 87, cap. 97).

It is, of course, quite impossible that I can give you every particular connected with legal forms; every one who undertakes the charge of a lunatic patient should make himself acquainted with the law on the subject by consulting special law treatises. I would recommend to you Phillips's Law of Lunatics,' or Archbold's 'Lunacy Acts.'

I am now speaking more particularly under the supposition that you are called upon to certify for the imposition of restraint, and will therefore only add (as medical practitioners occasionally are asked to receive a patient into their house for

The Acts directing these matters are 16 & 17 Vic., cap. 96, and 16 & 17 Vic., cap. 97; also 8 & 9 Vic., cap. 100.

At Shaw's, Fetter Lane.

treatment) that it is not legal for any one to exercise any authority over the liberty of an insane person, or any one "alleged to be so," without the sanction of the Commissioners in Lunacy, and without all the certificates I have mentioned.

If you receive a patient into your house and desire to restrain him in any way, as, say, from drink, or from going out to obtain drink, it would be necessary to have the person duly committed to your care by his relations, and with certificates, or, what would be better, perhaps, by an instrument duly signed by himself. The law is stringent. I wish I could positively assert it was equally clear on this point. The Act says (sec. 90, 8 & 9 Vic., cap. 100) that "no person deriving profit shall receive to board and lodge in his house a single patient who is a lunatic or alleged lunatic, without the authority of regular certificates." What kind of certificate could be given or received for an alleged lunatic the law does not say. The forms and certificates already mentioned are sufficient warranty (8 & 9 Vic., cap. 100, sec. 99), and justification for "taking, confining, detaining, or retaking such lunatic or alleged lunatic;" and if an action be brought against a medical man for the detention of such a patient, the party complained of may plead such order and certificates, and the Act says "they shall be a justification."

These forms are under the immediate surveillance of the Commissioners in Lunacy, and copies have to be sent to them. The patient's name is entered into their register, and they personally visit the detained patient at stated periods.

But I have hitherto assumed that you have been asked to certify-it may become your duty to advise that the imposition of restraint should be made; indeed, if you are in attendance upon a patient who is not 'duly controlled' from doing injury to himself or to others, a very great responsibility would rest upon you if you neglected to advise that sufficient safeguards against injury should be adopted. I have read of many serious accidents, and I have narrated many already in the course of these lectures, which would have been prevented by merely ordinary precautions. Should you have a dangerous lunatic under your care I would advise you to be very explicit in giving directions to the relatives or natural guardians that proper steps be taken to prevent injurious acts by the lunatic.