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fact, based on competent experience, and that which is mere opinion. Here, more than ever, do we suffer under an intolerable grievance in the fact that impartiality in the scientific advisers of the state is not merely unprovided for, but is rendered very nearly impossible, Whether the question be one of signing a certificate for the removal of a patient to an asylum, or of informing the Master in Lunacy or a jury as to the capability of an individual to manage his own affairs, matters stand in such a way that the slightest introduction of a hostile element in the shape of conflicting inte. rest at once causes the parties to enlist medical evidence on their respective sides; and this is done with a skill which it is chimerical to suppose that the medical body could have the tact and firmness to resist. At least, if some resist, others will certainly comply, and these by no means the least honourable members of the profession. The practice of signing certificates for the committal of patients to houses of restraint is a very important matter, because it is in constant operation, and because it has been made the ground of all kinds of suspicion against the candour and honesty of medical practitioners. The public has a chronic quarrel with “mad-doctors," as the pages of many a sensation novel will testify. It is obvious that nothing would so completely relieve the public mind of uncomfortable feelings on this score as the knowledge that all matters of certificate-signing would be performed by an official unconnected with the patient or his friends, and at the same time quali. fied by his superior knowledge and experience to make the certificate a really valuable report, instead of what it too often is at present—a hazy, incoherent, and nearly useless document, suggestive (to the Commissioners in Lunacy) of little else than the reflection that “ these doctors” are themselves the strangest psychological study which could be found.
Information on all questions of lunacy can only be usefully given to the state by men who have mastered the laws of evidence. These laws, which I have
already referred to in another relation, are especially important in connexion with questions of mental unsoundness. It is the simple truth that without a special and scientific knowledge of them it is a hopeless undertaking, even for one who has had large experience of mental diseases, to attempt to convey to laymen the true state of science on many questions in lunacy. But at present the possession of such knowledge hardly enters at all into the popular conception of the necessary qualifications of a witness in lunacy, and certainly it is not every medical man who has acquired it. It is this kind of ignorance, more than any other, that conduces to the occurrence of scandals like the Townley and Windham affairs.
I I. I come now to the practical part of my paper, in which I hope to show that the great evils which disfigure our present administration of state medicine, and which are far too gigantic to be remedied by any unaided efforts on the part of the medical profession, might be removed in great measure, if a helping hand were reached to us from without
Here is a great mass of work the general characters of which are similar in all its branches; the central feature of all the functions which I have referred to being the reduction of high scientific mysteries to terms of popular intelligibility. At present it is performed in a scattered and disjointed way,-by persons in most cases without special knowledge either of the scientific facts or of the true way of making them intelligible by and useful to the state,--and under the disabling pressure of circumstances which render impartiality almost impossible. It would seem certain that any effective principle of reform must include the consolidation of these functions, the strict limitation of the power to exercise them to men who should be able to give proofs of their possessing the special knowledge required, and the remuneration of such persons in a way which would render them independent of the favour of private individuals. There are many
persons, doubtless, who will be ready science and medical police in this country, at once to declare that any such scheme from a want of any proper organization is Utopian, and its execution impossible. on the part of those on whom their I believe they are mistaken, and that maintenance and extension depends. the real Utopianism consists in thinking The principal feature of Mr. Rumsey's that the kind of machinery at present scheme is the appointment of district in vogue can effectually solve the ever- officers of health, who shall take cognimultiplying difficulties presented by the zance of all questions of vital statistics, relations of medical science to the state of sanitary police, and of forensic mediAlready the amount of work done for cine, which arise within their juristhe state by medical men (quite ex- diction, who shall possess a special clusive of the medical service of the educational qualification guaranteeing army and navy, which does not come their fitness for their office, and who under the head of state medicine proper) shall be sufficiently remunerated by is very considerable, and it is yearly the state, and expressly debarred from increasing. The powers wielded by the private practice. To the hands of such Privy Council—the present representa- officers the following duties should be tive of the old Board of Health-enable committed :—A. The scientific registrait to set on foot inquiries which must tion of births, of deaths and their causes, terminate sooner or later in a great and of the amount and kind of sickness development of the application of sani- occurring in their district. B. The intary science, and of vital statistics, to spection of vaccination. C. The exathe prevention of disease. The appoint- mination of articles of food and drink, ment of inspectors af vaccination may with a view to the detection of adulterbe looked on as one important recent ations. D. The preparation of scientific indication of this tendency; the special evidence in all cases of sudden and viomissions of inquiry into the origin of lent deaths, and in all cases of alleged particular epidemics of disease which personal incompetence—whether moral, have from time to time been sent out is mental, or physical—for the fulfilment another. The institution of officers of of public or family duties, or of labour health was a great stride in the same contracts, and to detect malingerers. direction. Obviously there must be in To this scheme must be added its the future a great deal of costly work natural complement, the list of suggesdone for the state by the medical pro- tions for a special examination in the fession; it seems worth while, there qualifications for these duties, which fore, to inquire whether it were not candidates for the new offices would be better for humanity, and ultimately even required to have passed. “It can hardly for humanity's pocket, to include in one be questioned,” says Mr. Rumsey, in a department, paid and guaranteed efficient valuable paper which, by his kindness, by the state, the various officers whose I have had the opportunity of reading, services advancing civilization will in. “that none of the ordinary medical evitably require ? That such an idea is “degrees or diplomas—whether from not altogether chimerical has been shown “Universities or from Medical Colleges by Mr. H. W. Rumsey in a series of "--distinctly express and embody the able papers 1 read before the Social “special qualifications required. Nor Science Association, in which that “ do any of the courses of instruction, gentleman took as his text the scan. “through which medical students are dalous inefficiency of our 80 - called “ obliged to pass, provide adequately for "returns" of birth and death, and “the acquirement of that exact knowwhich contain many forcible illustra “ ledge of particular subjects which such tions of the deplorable condition of vital “officers ought to possess.” This is
1 “Public Health : the Right Use of Records 1 "A Proposal for the Institution of Degrees founded on Local Facts." By Henry Wild. in Civil or State Medicine in the Universities bore Rumsey, J. W. Parker & Son. 1860. of the United Kingdom."
literally true. If Government were ever the process of reformation is commenced to adopt the above or any similar scheme, the better for us all. It may well be it must necessarily insist on a quali- that the scheme above propounded fication of its candidates which would (which is merely introduced here as the compel the addition of special items to work of an able man who has had the the curricula of the colleges, and to the courage to think this question resolutely programme of the examiners of even out) will be found to require great mo the most exigeante University. To say difications before it could be practically the least, it would be necessary to add, adopted. For details I must refer the even to the most stringent medical reader to Mr. Ramsey's pamphlet itself; examinations known, another in the suffice it to say that, with regard to one physical sciences, a searching practical most important matter, the probable examination in the diagnosis of mental expense of such a scheme, he adduces affections (in actual patients), and, figures which seem to prove that this finally, an examination on the laws of might be rendered moderate, indeed evidence both by papers and also vivá quite insignificant, in proportion to the voce—the latter being conducted by a advantages which the state would gain. barrister of standing.
I come back to the opinion which The adoption of any plan which would forms the groundwork of this paper, involve even these changes obviously that medical advisers of the state canpresents many serious educational diffi- not be taken with advantage at hapculties; and, in addition to this, it is hazard from the mass of general praccertain that the practical obstacles to titioners, pure surgeons and pure phyany legislation tending to interfere with sicians, who are devoting themselves to the vested interests which protect the the business of curing individual patients. present class of death-registrars and the I believe that absorption in ordinary present autocracy of vestries in sanitary practice is a fatal bar to the acquisition matters would be immense. It is also of that kind of knowledge and that skill possible that a certain amount of oppo- in communicating it which is indispensition might be offered by a portion of sable. And I would urge with especial the medical profession to any measure force the propriety of placing the man which took out of their hands such of science, from whom the state requires employment as is furnished by the information, in a position of indepenrequirements of coroners' inquests and dence. The few remaining words which assize trials, or the possible reversion, I have to say will be devoted to the in some cases, of a vestry appointment consideration of an evil, already touched as officers of health ; but I believe that upon, which offers the most pointed the feeling of opposition would be but example of the mischiefs arising from temporary in this case, and that the a neglect of this precaution. sense of relief to themselves and benefit The practice of receiving scientific to the community would quickly recon- evidence of an ex parte character is a discile the rank and file of the profession grace to our judicial processes. When, to an exclusion from duties for which on a criminal trial for instance, the questhey have had no opportunity of quali- tion of the prisoner's mental soundness fying themselves. I acknowledge to the becomes of importance, it is a gross full all the difficulties which stand in scandal that the jury should be left to the way of any plan of organization form their momentous decision from a But the mere statement of these diffi- haphazard balancing of two extreme culties, if we care to undertake it, statements of the scientific facts proforces us to a consideration of the pounded by two witnesses (or sets of actual state of things from which no witnesses) whose pecuniary and profesintelligent person can rise without the sional interests are bound up respectively feeling that at any cost reforms will with the prosecution and with the dehave to be made, and that the sooner fence. It is quite possible that the best
expression of the fullest science on particular questions would necessarily be less clear and decided than could be wished. But that is no reason why we should deliberately accept such a version of the scientific facts of a case as must, from the method in which it has been extorted, be nearly worthless. The idea that any effective check upon the abuses of scientific authority thus occasioned can be effectively imposed by counsel in the cross-examinations is ludicrous. Here and there an exceptionally able lawyer, like Sir A. Cockburn, prompted in his questions by exceptionally able medical advisers, will succeed in dispelling a cloud of sophistries such as those by which the plain and straightforward medical facts of Palmer's case were at tempted to be disguised ; but it would be a great mistake to take this hard-won piece of success as any specimen of the average result to be expected from the application of cross-examination in the event of contradictions arising in medical evidence.
The remedy which, sooner or later, I am convinced will have to be applied, is the institution of scientific coinmissioners as adjuncts to the ordinary apparatus of the courts, before whom, and not before a common jury, the strictly scientific questions shall be argued—the general question in respect to the legal charge being subsequently determined as at present. Supposing some such scheme as that which has been above proposed for district officers of health to have been carried out, these officers might be employed as commissioners in the followingway:—The officer for the particular district would ex officio collect all the scientific evidence by personal observation and interrogation on the spot, with the assistance of any ordinary medical attendant professionally cognisant of the facts. The whole mass of scientific facts would then be placed before the commission, which should consist of a certain limited number of experts selected in rotation from the district officers of health of the kingdom; and this body, with the assistance of the counsel for prosecution and defence,
should sift the facts and hear any other evidence which might be offered on the scientific questions. The commission would then come to as definite an opinion as was possible under the circumstances, and would embody this in a report to the court, which should be taken to be final as regards the scientific questions.
It would be difficult to believe that a scientific commission, chosen with these elaborate safeguards for its impartiality, would be more likely to be crotchety than a common jury of small shopkeepers. On the contrary, it would be an impossibility that half a dozen men, each of the scientific rank which is here presupposed, and entirely independent of the others as regards authority, should allow such perverse and baseless theories as those which frequently astonish and impress a jury of half-educated laymen to have any weight with them at all. Nor would such a body be afraid to confess the true state of the case should it happen, in a particular instance, that science could give no definite answer to the inquiries addressed to it by the state.
Defend it as you will, the present system of allowing a knot of confused, bewildered, and often half-terrified laymen to give the final decision on matters of science, which in fact they now do, is simply monstrous. It has been attempted to excuse the existing state of things by the argument that it is not abstract truth, but the highest probability, that the jury are instructed to discover, and that consequently they need not trouble about the actual right or wrong of scientific opinion, but must simply judge what is the prevailing voice of the science of the day on the question in hand. But that is precisely what they cannot discover, save by a lucky accident, under the present system. The prevailing voice of science is not represented by any balance struck, by unscientific persons, between the extreme views held by the learned on either side : such haphazard guesswork often results in an opinion which has really no relation to the points in dispute. Nothing but the calm interchange of ideas between scientific men themselves can afford a chance of the elicitation of the truth on some of the more difficult questions involved in forensic inquiries—I mean the truth, not in the abstract, but so far as science already knows it.
Before concluding, I must answer one objection which is certain to be raised — namely, that no man could grasp effectively the great range of science involved in the multifarious duties indicated. This objection might readily be met by separating from the general duties of the office, which would be homogeneous in character, certain specialties which are at once very difficult and of a different nature from the ordinary duties. Chemistry is a good instance of this. It would be not only possible, but highly desirable, that elaborate chemical inquiries, such as those concerned in cases of suspected poisoning, should be taken out of the hands of toxicologists, and always decided, apart from any theoretical considerations in physiology, by officials like those, let us say, of the College of Chemistry. On the other hand, such comparatively
simple duties as those of food inspection and analysis might easily be performed by an official so qualified as we have supposed our district health-officers to be. This great relief being given, the remaining subjects which would occupy the attention of our district officer would be confined to a circle of science certainly not larger, one would say greatly less, than that which the ordinary practitioner of medicine is supposed to grasp. And we should be delivered from the uncomfortable spectacle, now so frequently thrust upon us, of worthy men, per, fectly well qualified for the latter branch of work, assuming at a moment's notice the functions of advisers of the state on the highly special and peculiar subjects which have been enumerated in this paper.
I am well aware that the ideas now put forward are difficult of realization. I am content, however, to wait the course of events. These ideas, which two years ago had not attracted much attention, have since that period received the notice of influential persons, and are already making distinct and perceptible progress.
BY THE LATE ALEXANDER GILCHRIST.
On eager feet, his heritage to seize,
From yon horizon dim stalks spectral Death !