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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 interest 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 qualified 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.

II. 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 per formed 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 impar tiality 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 at once to declare that any such scheme is Utopian, and its execution impossible. I believe they are mistaken, and that the real Utopianism consists in thinking that the kind of machinery at present in vogue can effectually solve the evermultiplying difficulties presented by the relations of medical science to the state. Already the amount of work done for the state by medical men (quite exclusive of the medical service of the army and navy, which does not come under the head of state medicine proper) is very considerable, and it is yearly increasing. The powers wielded by the Privy Council-the present representative of the old Board of Health-enable it to set on foot inquiries which must terminate sooner or later in a great development of the application of sanitary science, and of vital statistics, to the prevention of disease. The appointment of inspectors af vaccination may be looked on as one important recent indication of this tendency; the special missions of inquiry into the origin of particular epidemics of disease which have from time to time been sent out is another. The institution of officers of health was a great stride in the same direction. Obviously there must be in the future a great deal of costly work done for the state by the medical profession; it seems worth while, therefore, to inquire whether it were not better for humanity, and ultimately even for humanity's pocket, to include in one department, paid and guaranteed efficient by the state, the various officers whose services advancing civilization will inevitably require? That such an idea is not altogether chimerical has been shown by Mr. H. W. Rumsey in a series of able papers read before the Social Science Association, in which that gentleman took as his text the scandalous inefficiency of our so-called 66 "returns of birth and death, and which contain many forcible illustrations of the deplorable condition of vital

1 "Public Health: the Right Use of Records founded on Local Facts." By Henry Wildbore Rumsey. J. W. Parker & Son. 1860.

science and medical police in this country, from a want of any proper organization on the part of those on whom their maintenance and extension depends. The principal feature of Mr. Rumsey's scheme is the appointment of district officers of health, who shall take cognizance of all questions of vital statistics, of sanitary police, and of forensic medicine, which arise within their jurisdiction, who shall possess a special educational qualification guaranteeing their fitness for their office, and who shall be sufficiently remunerated by the state, and expressly debarred from private practice. To the hands of such officers the following duties should be committed:-A. The scientific registration of births, of deaths and their causes, and of the amount and kind of sickness occurring in their district. B. The inspection of vaccination. C. The examination of articles of food and drink, with a view to the detection of adulterations. D. The preparation of scientific evidence in all cases of sudden and violent deaths, and in all cases of alleged personal incompetence-whether moral, mental, or physical-for the fulfilment of public or family duties, or of labour contracts, and to detect malingerers.

To this scheme must be added its natural complement, the list of suggestions for a special examination in the qualifications for these duties, which candidates for the new offices would be required to have passed. "It can hardly be questioned," says Mr. Rumsey, in a valuable paper which, by his kindness, I have had the opportunity of reading,1 "that none of the ordinary medical "degrees or diplomas-whether from "Universities or from Medical Colleges "-distinctly express and embody the "special qualifications required. Nor "do any of the courses of instruction, "through which medical students are

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obliged to pass, provide adequately for "the acquirement of that exact know"ledge of particular subjects which such "officers ought to possess." This is

1 "A Proposal for the Institution of Degrees in Civil or State Medicine in the Universities of the United Kingdom."

literally true. If Government were ever to adopt the above or any similar scheme, it must necessarily insist on a qualification of its candidates which would compel the addition of special items to the curricula of the colleges, and to the programme of the examiners of even the most exigeante University. To say the least, it would be necessary to add, even to the most stringent medical examinations known, another in the physical sciences, a searching practical examination in the diagnosis of mental affections (in actual patients), and, finally, an examination on the laws of evidence both by papers and also virá voce-the latter being conducted by a barrister of standing.

The adoption of any plan which would involve even these changes obviously presents many serious educational difficulties; and, in addition to this, it is certain that the practical obstacles to any legislation tending to interfere with the vested interests which protect the present class of death-registrars and the present autocracy of vestries in sanitary matters would be immense. It is also possible that a certain amount of opposition might be offered by a portion of the medical profession to any measure which took out of their hands such employment as is furnished by the requirements of coroners' inquests and assize trials, or the possible reversion, in some cases, of a vestry appointment as officers of health; but I believe that the feeling of opposition would be but temporary in this case, and that the sense of relief to themselves and benefit to the community would quickly reconcile the rank and file of the profession to an exclusion from duties for which they have had no opportunity of qualifying themselves. I acknowledge to the full all the difficulties which stand in the way of any plan of organization. But the mere statement of these difficulties, if we care to undertake it, forces us to a consideration of the actual state of things from which no intelligent person can rise without the feeling that at any cost reforms will have to be made, and that the sooner

the process of reformation is commenced the better for us all. It may well be that the scheme above propounded (which is merely introduced here as the work of an able man who has had the courage to think this question resolutely out) will be found to require great modifications before it could be practically adopted. For details I must refer the reader to Mr. Rumsey's pamphlet itself; suffice it to say that, with regard to one most important matter, the probable expense of such a scheme, he adduces figures which seem to prove that this might be rendered moderate, indeed quite insignificant, in proportion to the advantages which the state would gain.

I come back to the opinion which forms the groundwork of this paper, that medical advisers of the state cannot be taken with advantage at haphazard from the mass of general practitioners, pure surgeons and pure phy sicians, who are devoting themselves to the business of curing individual patients. I believe that absorption in ordinary practice is a fatal bar to the acquisition of that kind of knowledge and that skill in communicating it which is indispensable. And I would urge with especial force the propriety of placing the man of science, from whom the state requires information, in a position of independence. The few remaining words which I have to say will be devoted to the consideration of an evil, already touched upon, which offers the most pointed example of the mischiefs arising from a neglect of this precaution.

The practice of receiving scientific evidence of an ex parte character is a disgrace to our judicial processes. When, on a criminal trial for instance, the question of the prisoner's mental soundness becomes of importance, it is a gross scandal that the jury should be left to form their momentous decision from a haphazard balancing of two extreme statements of the scientific facts propounded by two witnesses (or sets of witnesses) whose pecuniary and profes sional interests are bound up respectively with the prosecution and with the defence. 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 attempted 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 commissioners 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 following way:-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 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 certain-
ly not larger, one would say greatly less,
than that which the ordinary practitioner
of medicine is supposed to grasp.
we should be delivered from the uncom-
fortable 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 sub-
jects which have been enumerated in
this paper.

And

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.

LIFE-A SONNET.

BY THE LATE ALEXANDER GILCHRIST.

ON eager feet, his heritage to seize,

A traveller speeds toward the promised land.
Afar gloom purple slopes on either hand;

Glad earth is fragrant with the flowering leas;

The green corn stirs in noon's hot slumberous breeze,
And whispering woodlands nigh make answer grand.
That pilgrim's heart as by a magic wand

Is swayed: nor, as he gains each height, and sees
A gleaming landscape still and still afar,
Doth Hope abate, nor less a glowing breath
Wake subtle tones from viewless strings within.
But lo! upon his path new aspects win;

Dun sky above, brown wastes around him are;
From yon horizon dim stalks spectral Death!
GUILDFORD, June, 1856.

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