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SENILE INSANITY

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Originally appearing in Volume V14, Page 618 of the 1911 Encyclopedia Britannica.
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SENILE

INSANITY  .-States of
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mental enfeeblement are always the result of failure of development or of structural changes in ~n1k the cortical grey
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matter of the brain . If the enfeeble-Insanity. merit is due to failure of development or brain damage occurring in early
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life, it is spoken of as idiocy or imbecility . Every form of insanity which occurs after a certain period of life is
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apt to be regarded by some observers as senile, but although the failing mental power may colour the character of the symptoms it cannot be regarded as correct to designate, for instance, a recurrent form of
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mania as senile merely because it necessarily manifests itself in a subject who has lived into the senile period . On the other hand, many persons first suffer from mental derangement at an advanced period of life without at the same time manifesting any marked failure of mental power, while others only manifest their insanity as a result of the decay of their mental faculties . From this statement it will be seen that senile insanity is a complex of different conditions, some of them accompanied by dementia, others without dementia . Senile Dementia is distinguished occasionally 'into " senile " properly so called, and " presenile " dementia, which supervenes at
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middle age or even• earlier . The occurrence of dementia is sometimes preceded by an acute hallucinatory phase, accompanied by mania or
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melancholia; but as a general
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rule, in the presenile cases, by neurasthenia, indifference, and mental apathy which extends to a disregard for the ordinary conventions and the means of subsistence . It has pithily been remarked that the age of a man is the age of his
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blood-vessels . The two conditions of senile and presenile dementia cannot therefore be separated scientifically . From a clinical point of view, however, the two are distinguishable in so far as their symptoms are concerned, for the presenile cases are more
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complete and the
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process of dementia achieves its consummation earlier and quicker, while in the senile the gradual disease of the arteries and the slow decay of the mental faculties offer a different background for the manifestation of mental symptoms . Moreover, the senile patients more frequently
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present symptoms of recurrent attacks of acute insanity, a more pronounced emotionalism, and a greater tendency to restlessness at
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night . The presenile cases, on the other hand, except at the commencement of their malady, are usually
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free from acute and troublesome symptoms and present chiefly an.apathetic indifference and irresponsiveness on the mental side, and on thephysical side a neurasthenic and enfeebled bodily state .

In both conditions memory is greatly impaired . Added to senile dementia there is often found a

condition of mania or melancholia or even of systematized delusional insanity . The chief symptoms of the maniacal attacks are the
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great motor restlessness and excitement, which are worst during the night time . Sleep is almost always seriously disturbed, and the patients rapidly become exhausted unless carefully nursed and tended . The, actions of senile maniacs are often puerile and foolish, and they may exhibit impulses of a homicidal, suicidal or sexual character . The melancholic cases are also extremely restless, and their emotion is loudly expressed in an uncontrollable manner . They often have delusions of persecution . Their cries and groans have an automatic character, as if the patient, though compelled to utter them, did not experience the mental pain which he expressed . They also, many of them, eat their food ravenously, although a few obstinately refuse it . The senile delusional cases may manifest any of the classical forms of paranoia described above, but their delusions are of a rudimentary and unfinished type . The most
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common of all senile delusions is that they are being robbed . They therefore often hide their small valuables in corners and out-of-the-way places, and as their memories are very defective they are afterwards unable to find them .

Others, who live alone,

barricade their doors and try to prevent any one entering for fear of thieves . Delusions of ambition in senile subjects are usually of a very improbable and childish character . Hallucinations are generally present in the senile delusional cases . The treatment of senile insanity is from the medical point of view not hopeful; it resolves itself largely into instructions for careful
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nursing, suitable feeding, and the
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protection of the patient from all the
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physical dangers to which he may be exposed .
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Statistics.-The statistics of lunacy are merely of
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interest from a sociological point of view; for under that
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term are comprised all forms of insanity . It is needless to produce tables illustrative of the relative numbers of lunatics in the various countries of
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Europe, the systems of
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registration being so unequal in their working as to afford no trustworthy basis of comparison . Even in Great Britain, where the systems are more perfect than in any other country, the tables published in the Blue Books of the three countries can only be regarded as approximately correct, the difficulty of registering all cases of lunacy being insuperable . On the 1st of
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January 1907, according to the returns made to the offices of the Commissioners in Lunacy, the numbers of lunatics stood thus on the registers:-
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Males .
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Females . Totals . England and Wales . . 57,176 66,812 123,988 Scotland 8,594 8,999 17,593 Ireland 12,254 11,300 23,554
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Gross
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total 78,024 87,111 165,135 These figures show the ratio of lunatics to 100,000 of the population to be 354 in England and Wales, 312 in Scotland, and 538 in Ireland .

Numbers of Lunatics on the 1st of January of the years 1857-1907 inclusive, according to Returns made to the Offices of the Commissioners in Lunacy for England and Wales, Scotland and Ireland . Years . England Scotland . Ireland . and Wales . 1858 5,823 1859 36,762 6,072 186o 38,058 6,273 1861 39,647 6,327 1862 41,129 6,398 8,055 1863 43,118 6,386 7,862 1864 44,795 6,422 8,272 1865 45,950 6,533 8,845 1866 47,648 6,730 8,964 1867 49,086 6,888 8,962 1868 51,000 7,055 9,086 1869 53,177 7,310 9,454 187o 54,713 7,571 Io,o82 1871 56,755 7,729 10,257 1872 58,64o 7,849 10,767 1873 60,296 7,982 10,958 Years . England Scotland . Ireland . and Wales . 1874 60,027 8,069 I1,326 1875 63,793 8,225 11,583 1876 64,916 8,5o9 11,777 1877 66,636 8,862 12,123 1878 68,538 9,097 12,380 1879 69,885 9,386 12,585 188o 71,191 9,624 12,819 1881 73,113 10,012 13,062 1882 74,842 10,355 13,444 1883 76,765 10,510 13,882 1884 78,528 10,739 14,088 1885 79,704 10,918 14,279 1886 80,156 11,187 14,590 1887 80,891 11,309 14,702 1888 82,643 11,609 15,263 1889 84,340 11,954 15,685 1890 86,067 12,302' 16,159 1891 86,795 12,595 16,251 1892 87,848 12,799 16,688 1893 89,822 13,058 17,124 1894 92,067 13,300 17,276 1895 94,081 13,852 17,665 1896 96,446 14,093 18,357 1897 99,365 14,500 18,966 1898 101,972 14,906 19,590 1 899 105,086 15,399 20,304 1900 106,611 15,663 20,863 1901 107,944 15,899 21,169 1902 110,713 16,288 21,630 1903 113,964 16,658 22,138 1904 117,199 16,894 22,794 1905 '19,829 17,241 22,996 1906 121,979 17,450 23,365 1907 123,988 17,593 23,554 There is thus an increased ratio in England and Wales of lunatics to the population (which in 1859 was 19,686,701, and in 1907 was estimated at 34,945,600) of 186.8 per

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Ioo,000 as against 3 54.8, and in Scotland of 15.7 as against 312 per Ioo,000 . The Irish figures on the same basis have increased from 130.9 in 1862 to 538.1 in 1907 . The publication of these figures has given rise to the question whether lunacy has actually become more prevalent during the last twenty years, whether there is real increase of the disease .

There is a

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pretty general consent of all authorities that if there has been an increase it is very slight, and that the apparent increase is due, first to the improved systems of registration, and secondly (a far more powerful reason) to the increasing tendency among all classes, and especially among the poorer class, to recognize the less pronounced forms of mental disorder as being of the nature of insanity . Thirdly, the grant of four shillings per week which in 1876 was made by parliament from imperial
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sources for the maintenance of pauper lunatics has induced parochial authorities to regard as lunatics a large number of weak-minded paupers, and to force them into asylums in order to obtain the benefit of the grant and to relieve the rates . These views receive support from the fact that the increase of private patients, i.e. patients who are provided for out of their own funds or those of the
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family, has advanced in a vastly smaller ratio . In their case the increase, small as it is, can be accounted for by the growing disinclination on the
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part of the community to tolerate irregularities of conduct due to mental disease . And again, careful inquiry has failed to show a proportional increase of admissions into asylums of such well-marked forms as general paralysis, puerperal mania, &c . The main cause of the registered increase of lunatics is thus to be sought for in the improved registration, and parochial and family convenience . If there is an actual increase, and there is reason for believing that there is a slight actual increase, it is due to the tendency of the population to gravitate towards towns and cities, where the conditions of
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health are inferior to those of rural life, and where there is therefore a greater disposition to disease of all kinds . The futility of seeking for accurate figures bearing on the relative number of lunatics in other countries is illustrated by the tables set forth in a report by the
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United States Census Bureau . They shaw that the 'number of registered lunatics in 1903 was 150,151; in 189o, 74,028; and in 188o, 40,942 . An attempt was made in 1890 to estimate the number of insane persons outside of hospitals, which was stated to be 32,457 . In 1903 no such attempt was made, as it was admitted that so many sources of fallacy existed as to render it useless . Thus the mere statement that of every ioo,000 of the population (calculated at 8o,00o,000) 186.2 were registered as insane is of no value .

The

Pathology of Mind (1895) ; Bevan Lewis, A Text-
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Book of Mental Diseases (1899); Clouston, Clinical 'Lectures on Mental Diseases (1892); Kraepelin, Psychiatrie (1893); Krafft-Ebing, Lehrbuch der Psychiatrie (3893); Regis, A
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Practical
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Manual of Mental
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Medicine (
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London, 1895); Magnan, Lecons cliniques sur
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les maladies mentales (1897); Mendil, Leitfaden der Psychiatrie (1902); Mercier, A Text-Book of Insanity (1902); Lewis C . Bruce, Studies in Clinical Psychiatry (1906); Macpherson, Mental Affections (1899); Brower-Bannister, Practical Manual of Insanity (1902); Ford Robertson, Text-Book of Pathology in Relation to Mental Diseases (1900) . (J . B . T.; J . Mx.; L . C . B.) II . LEGAL ASPECTS The effect of insanity upon responsibility and
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civil capacity has been recognized at an early period in every
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system of law .
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Roman Law.-In the Roman jurisprudence its consequences were very fully
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developed, and the provisions and terminology of that system have largely affected the subsequent legal treatment of the subject . Its leading principles were
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simple and well marked . The insane person having no intelligent will, and being thus incapable of consent or voluntary
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action, could acquire no right and incur no responsibility by his own acts (see Sohm's Inst .

Roman Law, 3rd ed. pp . 216, 217, 219); his person and

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property were placed after inquiry by the magistrate under the control of a curator, who was empowered and bound to
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manage the property of the lunatic on his behalf (Sohm, p . 513; Hunter, Roman Law, pp . 732-735) . The different terms by which the insane were known, such as demens, furiosus, fatuus, although no doubt signifying different types of insanity, did not in Roman law infer any difference of legal treatment . They were popular names, which all denoted the complete deprivation of reason .
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Medieval Law.-During the middle ages the insane were little protected . Their legal acts were annulled, and their property placed under control, but little or no attempt was made to supervise their
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personal treatment . In England the wardship of idiots and lunatics, which was annexed before the reign of
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Edward II. to the king's
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prerogative, had regard chiefly to the control of their lands and estates, and was only gradually elaborated into the systematic control of their persons and property now exercised under the jurisdiction in lunacy . Those whose means were insignificant were
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left to the care of their relations or to charity . In criminal law the plea of insanity was unavailing except in extreme cases . About the beginning of the 19th century a very considerable change commenced .

The public

attention was strongly attracted to the miserable condition of the insane incarcerated in asylums without any efficient check or inspection; and at the same time the medical knowledge of insanity entered on a new phase . The possibility and advantages of a better treatment of insanity were illustrated by eminent physicians, Philippe Pinel in France, H .
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Tuke in England, Bond, B . Rush and I . Ray in the United States; its physical origin became generally accepted; its mental phenomena were more carefully observed, and its relation was established to other mental conditions .
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Modern Law.-From this period we date the commencement of legislation such as that known in England as the Lunacy Acts, which aimed at the regulation and control of all constraint applied to the insane . Hitherto, the criteria of insanity had been very rude, and the evidence was generally of a loose and popular character; but, whenever it was fully recognized that insanity was a disease with which physicians who had studied the subject were peculiarly conversant, expert evidence obtained increased importance, and from this time became prominent in every case . The newer medical views of insanity were thus brought into • contact with the old narrow conception of the law courts, and a controversy arose in the field of criminal law which in England, at least, still continues . Relations between Insanity and Law.-The fact of insanity may operate in law-(r) by excluding responsibility for crime; (2) by invalidating legal acts; (3) by affording ground for depriving the insane person by a legal process of the control of his person and property; or (4) by affording ground for putting him under restraint . Legal Terminology.-Bef ore proceeding, however, to
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deal with these matters in succession, it may be desirable to say something with regard to the chief legal terms respecting persons suffering under mental disabilities . The subject is now of less importance than formerly, because the modern tendency of the law is to determine the capacity or responsibility of a person alleged to be insane by considering it with reference to the particular matter or class of matters which brings his mental condition sub judice . But the literature of the law of lunacy cannot be clearly understood unless the distinctions between the different terms employed to describe the insane are kept in view .

The term non compos mentis is as old as the

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statute De praerogativa regis (1325), and is used sometimes, as in that statute, to indicate a
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species contrasted with idiot, sometimes (e.g. in Co . Litt . 246 (b)) as a genus, and afterwards, chiefly in statutes
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relating to the insane, in connexion with the terms " idiot " and " lunatic " as a word ejusdem generic . The word " idiot " (Gr . 'ZStos, a private person, one who does not hold any public office, and i u.'or7s, an ignorant and illiterate person) appears in the statute De praerogativa regis as fatuus naturalis, and it is placed in contradistinction to non compos mentis . The " idiot " is defined by
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Sir E . Coke (4 Rep . 124 (b)) as one who from his nativity, by a perpetual infirmity, is non compos mentis, and Sir M . Hale (Pleas of the
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Crown, i . 29) describes idiocy as " fatuity a nativitate
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vet dementia naturalis." In early times various artificial criteria of idiocy were suggested . Fitzherbert's test was the capacity of the alleged idiot to count twenty pence, or tell his age, or who were his
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father and
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mother (De natura brevium, 233) . Swinburne proposed as a criterion of capacity, inter alia, to measure a yard of
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cloth or name the days in the week (Testaments, 42) .

Hale propounded the sounder view that " idiocy or not is a question of fact triable by

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jury and sometimes by inspection " (Pleas of the Crown, i . 29) . The legal incidents of idiocy were at one time distinct in an important particular from those of lunacy . Under the statute De praerogativa regis the king was to have the rents and profits of an idiot's lands to his own use during the life of the idiot, subject merely to an
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obligation to provide him with necessaries . In the case of the lunatic the king was a trustee, holding his lands and tenements for his benefit and that of his family . It was on account of this difference in the legal
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con-sequences of the two states that on inquisitions distinct writs, one de idiota inquirendo, the other de lunatico inquirendo, were framed for each of them . But juries avoided finding a verdict of idiocy wherever they could, and the writ de idiota inquirendo fell into desuetude . A further blow was struck at the distinction when it came to be recognized even by the legislature (see the Idiots Act 1886) that idiots are capable of being educated and trained, and it was practically abolished when the Lunacy Regulation Act 1862, in a provision reproduced in substance in the Lunacy Act 1890, limited the evidence admissible in proof of unsoundness of mind on an inquisition (without
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special leave of the Master trying the case) to a period of two years before the date of the inquiry, and raised a
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uniform issue, viz. the state of mind of the alleged lunatic at the time when the inquisition is held . The term " lunatic," derived from the Latin luna in con-sequence of the notion that the moon had an influence on mental disorders,' does not appear in the statute-book till the time of Henry VIII . (1541) . Coke defines a lunatic as a " person who has sometimes his understanding and sometimes not, qui gauulet lucidis intervallic, and therefore he is called non compos mentis so long as he has not understanding " (Co . Litt .

247 (a), 4 Rep . 124 (h)) . Hale defines " lunacy " as " interpolated " (i.e. intermittent) dementia accidentalis vet adventitia, whether total or (a description, it will be observed, of " partial insanity ") quoad hoc vet illud (Pleas of the Crown, i . 29) . In modern times, the word " lunacy " has lost its former precise signification . It is employed sometimes in the strict sense, sometimes in contra-distinction to " idiocy " or " imbecility "; once at least—viz. in the Lunacy Act 189o—as including " idiot "; and frequently ' The word for " lunatic " in several other

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languages has a similar etymology . Cp . Ital. lunatico, Span. alunado, Gr . QeXnvu uK t (epileptic), Ger. mondsuchtig.in conjunction with the vague terms " unsound mind " (non-sane memory) and " insane." Section 116 of the Lunacy Act 1890 has by implication extended the meaning of the term lunacy so as to include for certain purposes the incapacity of a person to manage his affairs through mental infirmity arising from disease or age . " Imbecility " is a state of mental weakness " between the limits of absolute idiocy on the one hand and of perfect capacity on the other " (see 1 Haggard,
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Eccles . Rep. p . 401) .

1 . The Criminal Responsibility of the Insane.—The law as to the criminal responsibility of the insane has pursued in England a curious course of development . The views of Coke and Hale give the best exposition of it in the 17th century . Both were agreed that in criminal causes the act and wrong of a madman shall not be imputed to him; both distinguished, although in different

language, between dementia naturalis (or a nativitate) and dementia accidentalis or adventitia; and the main points in which the writings of Hale mark an advance on those of Coke are in the elaboration by the former of the
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doctrine of " partial insanity," and his adoption of the level of understanding of a child of fourteen years of age as the test of responsibility in criminal cases (Pleas of the Crown, i . 29, 30; and see Co . 4 Rep . 124 (b)) . In the 18th century a test, still more unsatisfactory than this " child of fourteen " theory, with its identification of " healthy immaturity " with " diseased maturity " (Steph . Hist . Crim . Law, ii . 150), was prescribed .

On the trial of Edward

Arnold in 1723 for firing at and wounding Lord Onslow, Mr Justice Tracy told the jury that " a prisoner, in order to be acquitted on the ground of insanity, must be a man that is totally deprived of his understanding and memory, and doth not know what he is doing, no more than an infant, than a brute or wild beast." In the beginning of the 19th century a fresh statement of the test of criminal responsibility in mental disease was attempted . On the trial of Hadfield for
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shooting at George III. in Drury Lane Theatre on 15th May 1800, Lord Chief Justice Kenyon charged the jury in the following terms: " If a man is in a deranged state of mind at the time, he is not criminally answerable for his acts; but the material part of the case is whether at the very time when the act was committed the man's mind was sane." The practical effect of this ruling, had it been followed, would have been to make the question of the
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amen-ability of persons alleged to be insane to the criminal law very much one of fact, to be answered by juries according to the particular circumstances of each case, and without being aided or embarrassed by any rigid
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external standard . But in 1812, on the trial of Bellingham for the
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murder of Mr Perceval, the First Lord of the
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Treasury, Sir James Mansfield propounded yet another criterion of criminal responsibility in mental disease, viz. whether a prisoner has, at the time of committing an offence, a sufficient degree of capacity to distinguish between good and evil . The objection to this doctrine consisted in the fact, to which- the writings of
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Continental and
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American jurists soon afterwards began to give prominence, that there are very many lunatics whose general ideas on the subject of right and wrong are quite unexceptionable, but who are yet unable, in con-sequence of delusions, to perceive the wrongness of particular acts . Sir James Mansfield's statement of the law was discredited in the case (4 State Tri . (n.s.) 847; 10 Cl. and Fin . 200) of Daniel Macnaughton, ten's cnaugh- c who was tried in ton's C se . ase . March 1843, before Chief Justice Tindal, Mr Justice Williams and Mr Justice Coleridge, for the murder of Mr Drummond, the private secretary of Sir Robert Peel . Mr (afterwards Lord Chief Justice) Cockburn, who defended the prisoner, used Hale's doctrine of partial insanity as the foundation of the defence, and secured an acquittal, Chief Justice Tindal telling the jury that the question was whether Macnaughton was capable of distinguishing right from wrong with respect to the act with which he stood charged . This judicial approval of the doctrine of partial insanity formed the subject of an animated debate in the House of Lords, and in the end certain questions were put by that House to the judges, and answered by Chief Justice Tindal on behalf of all his colleagues except Mr Justice
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Maule, who gave
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independent replies . The answers to those questions are commonly called " The Rules in Macnaughton's case," and they still nominally contain the law of England as to the criminal responsibility of the insane .

The points affirmed by the Rules that must be noted here are the propositions that knowledge of the nature and quality of the particular criminal act, at the time of its

commission, is the test of criminal responsibility, and that delusion is a valid exculpatory plea, when, and only when, the fancies of the insane person, if they had been facts, would have been so . The Rules in Macnaughton's case are open to serious criticism . They ignore, at least on a literal interpretation, those forms of mental disease which may, for the present purpose, be roughly grouped under the heading " moral insanity," and in which the moral faculties are more obviously deranged than the mental—the affections and the will, rather than the reason, being apparently disordered . The test propounded with reference to delusions has also been strenuously attacked by medical writers, and especially by Dr Maudsley in his
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work on Responsibility in Mental Disease, on the ground that it first assumes a man to have a delusion in regard to a particular subject, and then expects and requires him to reason sanely upon it . It may be pointed out, however, that in thus localizing the range of the immunity which insane delusion confers, the criminal law is merely following the course which, Inutatis mutandis, the civil law has, with general acceptance, adopted in questions as to the contractual and testamentary capacity of the insane . The Rules in Macnaughton's case have, as regards moral insanity, undergone considerable modification . Soon after they were laid down, Sir (then Mr) James Fitz-James Stephen, in an article in the Juridical Papers, i . 67,on the policy of maintaining the existing law as to the criminal responsibility of the insane, foreshadowed the view which he subsequently propounded in his
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History of the Criminal Law, ii . 163, that no man wild was deprived by mental disease of the power of passing a fairly rational
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judgment on the moral character of an act could be said to " know " its nature and quality within the meaning of the Rules; and it has in
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recent years been found possible in practice so to manipulate the test of the criminal responsibility which they prescribed as to afford protection to the accused in the by no means infrequent cases of insanity which in its literal interpretation it would leave without excuse . In Scotland the Rules in Macnaughton's case are recognized, but, as in England, there is a tendency among judges to adopt a generous construction of them . Mental unsoundness in-sufficient to bar trial, or to exempt from punishment, may still, it is said, be present in a degree which is regarded as reducing the offence from a higher to a
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lower category,—a doctrine first practically applied in Scotland, it is believed, in 1867 by Lord Deas; and the fact that a prisoner is of weak or
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ill-regulated mind is often urged with success as a plea in mitigation of punishment . The
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Indian Penal Code (Act XLV. of 1860, § 84) expressly adopts the
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English test of criminal responsibility, but the qualifications noted in the case of Scotland have received some measure of judicial acceptance (see Mayne, Crim .

Law Ind., 3rd ed., pp . 403-419;

Nelson, Ind . Pen . Code, 3rd ed., pp . 135 et seq.) . The Rules in Macnaughton's case have also been adopted in substance in those colonies which have codified the criminal law . The following typical references may be given: 55 and 56 Vict . (Can.) c . 29, § II; 57 Vict . (N.Z.), No . 56 of 1893, § 23; No. rot of 1888 (St Lucia), § 5o; No . 5 of 1876 (Gold Coast), § 49 (b) ; No .

2 of 1883,

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art . 77 (
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Ceylon); No . 4 of 1871, art . 84 (Straits Settlements) . On the other hand, a departure towards a recognition of " moral insanity " is made by the
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Queensland Criminal Code (No . 9 of 1899), § 27 of which provides that " a person is not criminally responsible for an act " if at the time of doing it " he is in such a state of mental disease . . . as to deprive him ... of capacity to control his actions ": and the law has been defined in the same sense in the Cape of Good Hope in the case of Queen v . Hay (1899, 16 S.C.R . 290) . The Rules were rapidly reproduced in the United States, but the modern trend of American judicial opinion is adverse to them (see Clevenger, Med .
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Jur. of Ins. p . 125; Parsons v .

State (1887) 81

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Ala . 577) . On the Continent of Europe moral insanity and irresistible impulse are freely recognized as exculpatory pleas (see the French Code Penal, § 64 ; Belgian Code Penal, § 71; German Penal Code, § 51;
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Italian Penal Code, §§ 46, 47) . Not only is insanity at the time of the commission of an offence a valid exculpatory plea, but supervening insanity stays the action of the criminal law at every stage from arrest up to punishment . High treason was formerly an exception, but the statute making it so (33
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Hen . VIII. c . 20) was repealed in the time of Philip and Mary . The Home Secretary has power, under the Criminal Lunatics Act 1884 to order by warrant the removal of a prisoner, certified to be insane, to a lunatic asylum, before ' trial or after trial, whether under sentence of
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death or not . Prisoners dealt with under these provisions are styled " Secretary of State's lunatics." On the other hand, a prisoner who on arraignment appears, or is found by the jury to be unfit to plead, or who is found " guilty but insane " at the time of committing the offence—a verdict substituted by the Trial of Lunatics Act 1883 for the old verdict of " acquitted on the ground of insanity," in the hope that the formal conviction recorded in the new finding might have a deterrent effect on the mentally unstable—is committed to a criminal lunatic asylum by the order of the judge trying the case, to be detained there " during the king's pleasure." Lunatics of this class are called " king's pleasure lunatics." There was no doubt at common law as to the power of the courts to order the detention of criminal lunatics in safe custody, but, prior to 1800, the practice was varying and uncertain . On the acquittal of Hadfield, however, in that
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year for the attempted murder of George III., a question arose as to the provision which was to be made for his detention, and the Criminal Lunatics Act 1800, part of which is still in force, was passed to affirm the law on the subject . The Criminal Lunatics Act contains provisions similar to those of the Lunacy Act 1890, as to the discharge (conditional or absolute) and transfer of criminal lunatics and the detention of persons becoming pauper lunatics . The expenses of the maintenance of criminal lunatics are defrayed out of moneys provided by Parliament (Crim .

Luns . Act 1884, and

Hansard, 3rd series, vol. ccxc. p, 75; 139 Corn . Jo. pp . 336, 340, 344) . The Lunatics' Removal (India) Act 1851 provides for the removal to a criminal lunatic asylum in Great Britain of persons found guilty of crimes and offences in India, and acquitted on the ground of insanity . Similar provisions with regard to colonial criminal lunatics are contained in the Colonial Prisoners' Removal Act 1884; and the policy of this statute has been followed by No 5. of 1894 (New South Wales), and Ordin . No 2 of 1895 (Falkland Islands) . Indian law (see Act V. of 1898, §§ 464–475) and the
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laws of the colonies (the Cape Act No . 1 of 1897 is a typical example) as to the trial of lunatics are similar to the English . In Scotland all the criminal lunatics, except those who may have been removed to the ordinary asylums or have been discharged, are confined in the Criminal Asylum established at Perth in connexion with H.M.'s General Prison, and regulated by special acts (23 & 24 Vict . C . 105, and 40 & 41 Vict .

C . 53) . Provision similar to the English has been made for prisoners found insane as a bar to trial, or acquitted on the ground of insanity or becoming insane in confinement . In New

York, Michigan and other American states there are criminal lunatic asylums . Elsewhere insane criminals are apparently detained in state prisons, &c . The statutory rules as to the maintenance of criminal lunatic asylums, the treatment of the criminal insane, and the plea of insanity in criminal courts in
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America, closely resemble English practice . 1It has sometimes been stated that this power, which ought clearly, in the interests alike of prisoners and of the public, to be exercised with caution, is in fact exerted in an unduly large number of cases . The following figures, taken from the respective volumes of the Criminal Judicial Statistics, show the number of criminal lunatics certified insane before trial . In 1884-1885, out of a total of 938 criminal lunatics, 169 were so certified; in 1885-1886, 149 out of 890; in 1889-1890, 108 out of 926; in 1890-1891, 95 out of 900; in 1894, 78 out of 738; in 1895, 84 out of 757; in 1896, 88 out of 769; in 1897, 85 out of 764; in 1898, 17 out of 209; in 1899, 13 out of 159; in 1900, 12 out of 185; in 1901, 15 out of tog; in 1902, 7 out of 233; in 1903, II out of 229 . The only special point in Continental law calling for
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notice is the system by which official experts report for the guidance of the tribunals on questions of alleged criminal irresponsibility (see, e.g., the German Code of Penal Procedure, § 293, and cp . § 81) . 2 .

Insanity and Civil Capacity.—The law as to the civil capacity of the insane was for some time influenced in Great Britain by the view propounded by Lord

Brougham in 1848 in the case of Waring v . Waring, and by Sir J . P .
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Wilde in a later case, raising the question of the validity of a
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marriage, that, as the mind is one and indivisible, the least disorder of its faculties was fatal to civil capacity . In the leading case of Banks v . Good-
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fellow in 1870, the court of queen's bench, in an elaborate judgment delivered by Chief Justice Cockburn, disapproved of this doctrine, and in effect laid down the principle that the question of capacity must be considered with strict reference to the act which has to be or has been done . Thus a certain degree of unsoundness of mind is not now, in the absence of undue influence, a bar to the formation of a valid marriage, if the party whose capacity is in question knew at the time of the marriage the nature of the engagement entered into (but see 51 Geo . III. c . 37 as to the marriage of lunatics so found by inquisition) . Again, a man whose mind is affected may make a valid will, if he possesses at the time of executing it a memory sufficiently active to recall the nature and extent of his property, the persons who have claims upon his bounty, and a judgment and will sufficiently free from the influence of morbid ideas or external control to determine the relative strength of those claims . So far has this rule been carried, that in 1893
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probate was granted of the will of a lady who was a
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Chancery lunatic at the date of its execution, and died without the inquisition having been superseded . (Roe v .

Nix, 1893, p . 55.) It is also now settled that the simple con-

tract of a lunatic is voidable and not void, and is binding upon him, unless he can show that at the time of making it he was, to the knowledge of the other party, so insane as not to know what he was about . (Imperial Loan Co. v . Stone, 1892, 1 Q.B . 599) The test established by Banks v . Goodfellow is applied also in a number of minor points in which civil capacity comes into question, e.g. competency of the insane as witnesses . The law implies, on the part of a lunatic, whether so found or not, an obligation to pay a reasonable price for " necessaries " supplied to him; and the term " necessaries " means goods suitable to his condition in life and to his actual requirements at the time of sale and delivery,(Sale of Goods Act 1893) . The question of the liability of an insane person for tort appears still to be undecided (see
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Pollock on Torts, 7th ed. p . 53; Clerk and Lindsell on Torts, 2nd ed. pp . 39, 40; Law Quart . Rev. vol. xiii. p . 325) .

Supervening insanity is no bar to proceedings by or against a lunatic

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husband or wife for
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divorce or separation for previous matrimonial offences . It does not avoid a marriage nor constitute per se a ground either for divorce or for judicial separation . But cruelty does not cease to be a cause of suit if it proceeds from disorderly affections or want of moral control falling short of positive insanity; and possibly even cruelty springing from intermittent or recurrent insanity might be held a ground for judicial separation, since in such case the party offended against cannot obtain protection by securing the permanent confinement of the offending spouse . Whether insanity at the time when an alleged matrimonial offence was committed is a bar to a suit for divorce or separation is an open question; and in any event, in order that it may be so, the insanity must be of such a character as to have prevented the insane party from knowing the nature and consequences of the act at the time of its commission . The laws of Scotland, Ireland, India (see, e.g., Act IX. of 1872, § 12), the colonies and the United States are substantially identical with English law on the subject of the civil capacity of the insane . The German Civil Code (0569) recognizes the lunacy of a spouse as a ground for divorce, but only where the malady continues during at least three years of the union, and has reached such a pitch that intellectual inter-course between the spouses is impossible, and that every prospect of a restoration of -such association is excluded . If one of the spouses obtains a divorce on the ground of the lunacy of the otherthe former has to allow alimony, just as a husband declared to be the
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sole guilty party in a divorce suit would have to do (§§ 1585, 1578)- 3 . The Jurisdiction in Lunacy.—In order to effect a change in the status of persons alleged to be of unsound mind, and to bring their persons and property under control, the aid of the jurisdiction in lunacy must be invoked . Under the unrepealed statute De Praerogativa Regis (1325) the care and custody of lunatics belong to the Crown . But the Crown has, at least since the 16th century, exercised this branch of the prerogative by delegates, and principally through the Lord Chancellor—not as head of the Court of Chancery, but as the representative and delegate of the
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sovereign . Under the Lunacy Acts 1890 and 1891, the jurisdiction in lunacy is exercised first by the Lord Chancellor and such of the Lords Justices and other judges as may be invested with it by the sign-manual; and, secondly, by the two Masters in Lunacy, appointed by the Lord Chancellor, from members of the bar of at least ten years',
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standing, whose duties include the holding of inquisitions and
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summary inquiries, and the making of most of the consequential orders dealing with the persons and estates of lunatics . County court judges may also exercise a limited jurisdiction in lunacy in the case of lunatics as to whom a reception order has been made, if their entire property is under £200 in value, and no relative or friend is willing to undertake the management of it; in partnership cases where the assets do not exceed £500; and upon application by the guardians of any union for payment of expenses incurred by them in relation to any lunatic .

Persons of unsound mind are brought under the jurisdiction in lunacy either by an inquisition de lunatico inquirendo, or, in certain cases which will be adverted to below, by proceedings instituted under §116 of the Lunacy Act 1890, which is now the great practice section in the Lunacy Office . Prior to 1853 a special commission was issued to the Masters in each alleged case of lunacy . But by the Lunacy Regulation Act of that year a general commission was directed to the Masters, empowering them to proceed in each case in which the Lord Chancellor by order required an inquisition to be held . This procedure is still in force . A special commission would now be issued only where both Masters were personally interested in the subject of the inquiry, or for some other similar reason . An inquisition is ordered by the judge in lunacy (a term which does not, for this purpose, at present include the Masters, although this is one of the points in regard to which a change in the law has been suggested, on the

petition generally of a near relative of the alleged lunatic . The inquiry is held before one of the Masters, and a jury may be summoned if the alleged lunatic, being within the jurisdiction, demands it, unless the judge is satisfied that he is not competent to form and express such a wish; and even in that case the Master has power to
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direct trial by jury if he thinks
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fit on consideration of the evidence . Where the alleged lunatic is not within the jurisdiction the trial must be by jury; and the judge in lunacy may direct this mode of trial to be adopted in any case whatever . A few points of general interest in connexion with inquisitions must be noted . In practice
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thirty-four jurors are summoned by the
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sheriff, and not more than twenty-four are empanelled . Twelve at least must concur in the verdict . Counsel for the petitioner ought to act in the judicial spirit expected from counsel for the
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prosecution in criminal cases .

The issue to be determined on an inquisition is " whether or not the alleged lunatic is at the time of the inquisition of unsound mind, and incapable of managing himself and his affairs " (a special verdict may, however, be found that the lunatic is capable of managing himself, although not his affairs, and that he is not dangerous to others); and without the direction of the person holding the inquisition, no evidence as to the lunatic's conduct at any time being more than two years before the inquisition is to be receivable . This

limitation, both of the issue and of the evidence, was imposed with a view to preventing the recurrence of such cases as that of Mr Windham in 1861-1862, when the inquiry ranged over the whole life of an alleged lunatic,
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forty-eight witnesses being examined on behalf of the petitioners and ninety-one on behalf of the respondents, while the hearing lasted for thirty-four days . For the purpose of assisting the Master or jury in arriving at a decision, provision is made for the personal examination of the alleged lunatic by them on oath or otherwise, and either in open court or in private, as may be directed . The proceedings on inquisition are open to the public . When a person has been found lunatic by inquisition he becomes subject to the jurisdiction in lunacy, and remains so (unless he succeeds in setting aside the verdict by a "
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traverse "— a proceeding which ultimately comes before, and is determined by, the King's Bench Division in London or at the assizes) until his recovery, when the inquisition may be put an end to by a procedure technically known as " supersedeas," or by his death . The results of the inquisition are worked out in the Lunacy Office . The control of the estate, and, except where he was found incapable of managing his property only, of the person of the lunatic is entrusted to committees of the estate and person, who are appointed by, and accountable to, the Master in Lunacy, and whose legal position corresponds roughly with that of the tutors and curators of the civil law . The committee of the estate in particular exercises over the property of the lunatic, with the sanction or by the order of the Master, very wide powers of management and administration, including the raising of
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money by sale, charge or otherwise, to pay the lunatic's debts, or provide for his past or future maintenance, charges for permanent improvements, the sale of any property belonging to the lunatic, the execution of powers vested in him and the performance of contracts relating to property . The alternative method of bringing a person of unsound mind under lunacy jurisdiction was created by § 116 of the Lunacy Act 1890 . The effect of that section briefly is to enable the Master, on a summons being taken out in his chambers and heard before him, to apply the powers of management and administration summarized in the last preceding
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paragraph, without any inquisition, to the following classes of cases: lunatics not so found by inquisition, for the protection or administration of whose property any order was made under earlier acts; every person lawfully detained, within the jurisdiction of the English courts, as a lunatic, though not so found by inquisition; persons not coming within the foregoing categories who are " through mental infirmity arising from disease or age " incapable of managing their affairs; persons of unsound mind whose property does not exceed £2000 in value, or does not yield an
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annual income of more than £100; and criminal lunatics continuing insane and under confinement . In Scotland the insane are brought under the jurisdiction in lunacy by alternative methods, similar to the English inquisition and summary procedure, viz . " cognition," the trial taking place before the Lord President of the Court of Session, or any judge of that court to whom he may remit it, and a jury of twelve—see 31 & 32 Vict .

C . 100, and Act of

Sederunt of 3rd December 1868—and an application to the Junior Lord Ordinary of the Court of Session or (43 & 44 Vict. c . 4, § 4) to the Sheriff Court, when the estate in question does not exceed boo a year, for the appointment of a curator bons or judicial factor . The powers of the Lord Chancellor of Ireland with regard to lunatics are generally similar to those of the English Chancellor (see the Lunacy Regulations (Irelapd) Act 1871, 34 & 35 Vict. c . 22. and the Lunacy (Ireland) Act 1901, 1 Ed . VII. c . 17; also Colles on The Lunacy Regulation (Ireland)Act) . The main feature of the French system is the provision made by the Civil Code (arts . 489-512) for the
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interdiction of an insane person by the Tribunal of First Instance, with a right of
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appeal to the Court of Appeal, after a preliminary inquiry and a report by a family council (arts . 407, 408), consisting of six blood relatives in as near a degree of relationship to the lunatic as possible, or, in default of such relatives, of six relatives by marriage . The family council is presided over by the loge de Pair of the
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district in which the lunatic is domiciled . This system is also in force in
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Mauritius .

There are provisions, it may he noted, in Scots law for the interdiction of lunatics, either voluntarily or judicially (sec

Bell's Principles, § 2123) . The German Civil Code provides for insane persons being made subject to guardianship (vormundung), on conditions similar to those of Scots and French law (see Civil Code, §§ 6, 104 (1896, 1906), 645-679) . In the United States the fundamental procedure is an inquisition conducted on practically the same lines as in England . (Cf .
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Indiana, Rev . Stats . (1894) §§ 2715 et seq.;
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Missouri, Annot . Code (1892) §§ 2835 et seq.; New Mexico, General Laws (1880) c . 74 §§ 1 et seq.) . 4 . Asylum Administration.—Asylum administration in England is now regulated by the Lunacy Acts 1890 and 1891 . Receptacles for the insane are divisible into the following classes: (i.) Institutions for lunatics, including asylums, registered hospitals and licensed houses .

The asylums are provided by counties or boroughs, or by union of counties or boroughs . Registered hospitals are hospitals holding certificates of registration from the Commissioners in Lunacy, where lunatics are received and supported wholly or partially by voluntary contributions or charitable bequests, or by applying the excess of the payments of some patients towards the maintenance of others . Licensed houses are houses licensed by the Commissioners, or, beyond their immediate jurisdiction, by justices; (ii.) Workhouses—see article POOR LAW; (iii.) Houses in which patients are boarded out; (iv.) Private houses (unlicensed) in which not more than a single patient may be received . A person, not being a pauper or a lunatic so found by inquisition, cannot, in ordinary cases, be received and detained as a lunatic in any institution for the insane, except under a " reception order " made by a county court judge or stipendiary magistrate or specially appointed justice of the

peace . The order is made on a petition presented by a relative or friend of the alleged lunatic, and supported by two medical certificates, and after a private hearing by the judicial authority . The detention of a lunatic is, however, justifiable at common law, if necessary for his safety or that of others; and the Lunacy Act 1890, borrowing from the lunacy law of Scotland, provides for the reception of a lunatic not a pauper into an asylum, where it is expedient for his welfare or the public safety that he should be confined without delay, upon an " urgency order," made if possible by a near relative and accompanied by one medical certificate . The urgency order only justifies detention for seven days (the curtailment of this period to four days is proposed), and before the expiration of that period the ordinary procedure must be followed . " Summary reception orders" may be made by justices otherwise than on petition . There are four classes of cases in which such orders may be made, viz.: (i.) lunatics (not paupers and not wandering at large) who are not under proper care and control, or are cruelly treated or neglected; (ii.)
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resident pauper lunatics; (iii.) lunatics, whether pauper or not, wandering at large; (iv.) lunatics in workhouses . (As to pauper lunatics generally, see article PooR LAW.) A lunatic may also be received into an institution under an order by the Commissioners in Lunacy; and a lunatic so found by inquisition under an order signed by the committee of his person . The chief features of English asylum administration requiring notice are these .
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Mechanical restraint is to be applied only when necessary for surgical or medical purposes, or in order to prevent the lunatic from injuring himself or others .

The privacy of the

correspondence of lunatics with the Lord Chancellor, the Commissioners in Lunacy, &c., is secured . Provision is made for
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regular visits to patients by their relatives and friends . The employment of males for the custody of females is, except on occasions of urgency, prohibited . Pauper lunatics may be boarded out with relatives and friends . Elaborate provision is made for the official visitation of every class of receptacle for the insane . The duties of visitation are divided between the Commissioners in Lunacy, the Chancery Visitors and various other visitors and visiting committees . There are ten Commissioners in Lunacy—four unpaid and six paid, three of the latter being barristers of not less than five years' standing at the date of appointment, and three medical . The Commissioners in Lunacy, who are appointed by the Lord Chancellor, visit every class of lunatics except persons so found by inquisition . These are visited by the Chancery Visitors . There are three Chancery Visitors, two medical and one legal (a
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barrister of at least five years' standing at the date of his appointment),who are appointed and removable by the Lord Chancellor . The Chancery Visitors (together with the Master in Lunacy) form a Board, and have offices in the Royal Courts of Justice . In addition to these two classes of visitors, every asylum has a Visiting Committee of not less than seven members, appointed by the
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local authority; and the justices of every county and quarter-sessions borough not within the immediate jurisdiction of the Commissioners in Lunacy annually appoint three or more of their number as visitors of licensed houses .

Provision is made for the discharge of lunatics from asylums, &c., on recovery, or by habeas corpus, or by the various visiting authorities . Any person who considers himself to have been unjustly detained is entitled on discharge to obtain, free of expense, from the secretary to the Lunacy Commissioners a copy of the documents under which he was confined . The Irish [Lunacy Acts 1821–1890; Lunacy (Ireland) Act rgorl and Scottish [Lunacy Acts 1857 (20 & 21 Vict. c . 71), 1887 (5o & 5r Vict. c . 39)] asylum systems present no feature sufficiently different from the English to require

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separate notice, except that in Scotland " boarding out " is a regular, and not merely an incidental, part of asylum administration . The " boarding out " principle has, however, received its most extended and most successful application in the Gheel colony in Belgium . The patients, after a few days' preliminary observation, are placed in families, and, except that they are under ultimate control by a
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superior commission, composed of the governor of the province, the Procureur du Roi and others, enjoy complete liberty indoors as well as out of doors . The patients are visited by nurses from the infirmary, to which they may be sent if they become seriously ill or unmanageable . They are encouraged to work . The accommodation provided for them is prescribed, and is to be of the same quality as that of the household in which they live . Clothing is provided by the administration . In the French (see laws of 30th
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June 1838 and 18th December 1839) and German (see .

Journal of
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Comparative Legislation, n.s. vol. i. at pp . 271, 272) asylum systems the main features of English administration are also reproduced . The lunacy laws of the
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British colonies have also closely followed English legislation (cf . Ontario, R.S . 1897, cc . 317, 318;
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Manitoba, R.S . 1902, c . 8o; Victoria (No . 1113, 189o); New Zealand (No . 34 of 1882 and Amending Acts); Mauritius (No . 37 of 1858) . In America the different states of the Union have each their own lunacy legislation .

The

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national government provides only for the insane of the army and
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navy, and for those residing in the District of
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Columbia and in
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Alaska . The various laws as to the reception, &c., of the insane into asylums closely resemble English procedure . But in several states the verdict of a jury finding lunacy is a necessary preliminary to the
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commitment of private patients (
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Kentucky, Act of 1883, c . 900, § 14; Mary-
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land, R.S . 1878, c . J3, § 21;
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Illinois, R.S . 1874, c . 85, § 22) . The era of real hospitals for the insane began in the 19th century . There had been established here and there in different parts of the
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world, it is true, certain asylums or places of restraint before the beginning of the 19th century . We find mention in history of such a place established by monks at Jerusalem in the latter part of the 5th century . There is evidence that even earlier than this in
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Egypt and
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Greece the insane were treated as individuals suffering from disease .

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Egyptian priests employed not only
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music and the beautiful in nature and art as remedial agents in insanity, but recreation and occupation as well . A Greek physician protested against mechanical restraint in the care of the insane, and advocated kindly treatment, the use of music, and of some sorts of manual labour . But these ancient beneficent teachings were lost sight of during succeeding centuries . The prevailing idea of the pathology of insanity in Europe during the middle ages was that of demoniacal possession . The insane were not sick, but possessed of devils, and these devils were only to be exorcised by moral or spiritual agencies . Medieval therapeutics in insanity adapted itself to the etiology indicated . Torture and the cruellest forms of punishment were employed . The insane were regarded with abhorrence, and were frequently cast into chains and dungeons . Milder forms of mental disease were treated by other spiritual means—such as pilgrimages to the shrines of certain saints who were reputed to have particular skill and success in the exorcism of evil
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spirits . The shrine of St Dymphna at Gheel, in Belgium, was one of these, and seems to have originated in the 7th century, a shrine so famed that lunatics from all over Europe *ere brought thither for miraculous healing . The little
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town became a resort for hundreds of insane persons, and as long ago as the 17th century acquired the reputation, which still exists to this day, of a unique colony for the insane . At the present time the
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village of Gheel and its adjacent farming hamlets (with a population of some 13,000 souls) provides homes, board and care for nearly 2000 insane persons under medical and government supervision .

Numerous other shrines and

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holy wells in various parts of Europe were resorted to by the mentally afflicted—such as Glen-na-Galt in Ireland, the well of St Winifred, St Nun's
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Pool, St Fillans, &c . At St Nun's the treatment consisted of plunging the patient backwards into the
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water and dragging him to and fro until mental excitement
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abated . Not only throughout the middle ages, but far down into the 17th century, demonology and
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witchcraft were regarded as the chief causes of insanity . And the insane were frequently tortured, scourged, and even burned to death . Until as
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late as the middle of the 18th century, mildly insane persons were cared for at shrines, or wandered homeless about the country . Such as were deemed a menace to the community were sent to ordinary prisons or chained in dungeons . Thus large numbers of lunatics accumulated in the prisons, and slowly there grew up a sort of distinction between them and criminals, which at length resulted in a separation of the two classes . In time many of the insane were sent to cloisters and monasteries, especially after these began to be abandoned by their former occupants . Thus " Bedlam " (Bethlehem Royal Hospital) was originally founded in 1247 as a priory for the brethren and sisters of the Order of the
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Star of Bethlehem . It is not known exactly when lunatics were first received into Bedlam, but some were there in 1403 . Bedlarh was rebuilt as an asylum for the insane in 1676 . In 1815 a committee of the House of
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Commons, upon investigation,. found it in a disgraceful condition, the medical treatment being of the most antiquated sort, and actual inhumanity practised upon the patients .

Similarly the Charenton Asylum, just outside

Paris, near the park of
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Vincennes, was an old monastery which had been given over to the insane . Numerous like instances could be cited, but the interesting point to be borne in mind is, that with a general tendency to improvement in the condition of imbeciles upon public charge, idiots and insane persons came gradually to be separated from criminals and other paupers, and to be segregated . The process of segregation was, however, very slow . Even after it had been accomplished in the larger centres of
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civilization, the condition of these unfortunates in provincial districts remained the same . Furthermore, the transfer to asylums provided especially for them was not followed by any immediate improvement in the patients . Twenty-five years after Pinel had, in 1792, struck the chains from the lunatics huddled in the Salpetriere and Bicetre of Paris, and called upon the world to realize the horrible injustice done to this wretched and suffering class of humanity, a pupil of Pinel, Esquirol, wrote of the insane in France and all Europe: " These unfortunate
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people are treated worse than criminals, reduced to a condition worse than that of animals . I have seen them naked, covered with rags, and having only
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straw to protect them against the cold moisture and the hard stones they lie upon; deprived of air, of water to quench thirst, and all the necessaries of life; given up to mere gaolers and left to their surveillance . I have seen them in their narrow and filthy cells, without
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light and air, fastened with chains in these dens in which one would not keep wild beasts . This I have seen in France, and the insane are every-where in Europe treated in the same way." It was not until 1838 that the insane in France were all transferred from small houses of detention, workhouses and prisons to asylums specially constructed for this purpose . In Belgium, in the middle ages, the public executioner was ordered to expel from the towns, by flogging, the poor lunatics who were wandering about the streets . In 1804 the Code
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Napoleon " punished those who allowed the insane and mad criminals to run about free." In 1841 an investigation showed in Belgium thirty-seven establishments for the insane, only six of which were in good order . In fourteen of them chains and irons were still being used .

In

Germany, England and America, in 1841, the condition of the insane was practically the same as in Belgium and France . These facts show that no great advance in the humane and scientific care of the insane was made till towards the middle of the 19th century . Only then did the actual
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metamorphosis f asylums for detention into hospitals for treatment begin to take place . Hand in hand with this progress there has grown, and still is growing, a tendency to subdivision and specialization of hospitals for this purpose . There are now hospitals for the acutely insane, others for the chronic insane, asylums for the criminal insane, institutions for the feeble-minded and idiots, and colonies for epileptics . There are public institutions for the poor, and well-appointed private retreats and homes for the rich . All these are presided over by the best of medical authorities, supervised by unsalaried boards of trustees or managers, and carefully inspected by Government lunacy commissioners, or boards of charities—a contrast, indeed, to the gaols, shrines, holy wells, chains, tortures, monkish exorcisms, &c., of the past ! The statistics of insanity have been fairly well established . The ratio of insane to normal population is about x to 300 among civilized peoples . This proportion varies within narrow limits in different races and countries . It is probable that intemperance in the use of
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alcohol and drugs, the spread of venereal diseases, and the over-stimulation in many directions induced by modern social conditions, have caused an increase of insanity in the rgth as compared with past centuries . The amount of such increase is probably very small, but on superficial examination might seem to be large, owing to the accumulation of the chronic insane and the constant upbuilding of asylums in new communities .

The imperfections of census-taking in the past must also be taken into account . The modern hospital for the insane does

credit to latter-day civilization . Physical restraint is no longer practised . The day of chains—even of wristlets, covered cribs and strait-jacketsis past . Neat dormitories, cosy single rooms, and sitting- anddining-rooms please the eye . In the place of
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bare walls and floors and curtainless windows, are pictures,
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plants, rugs, birds, curtains, and in many asylums even the barred windows have been abolished . Some of the wards for milder patients have unlocked doors . Many patients are trusted alone about the grounds and on visits to neighbouring towns . An air of busy occupation is observed in sewing-rooms,
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schools, shops, in the fields and gardens, employment contributing not only to
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economy in administration, but to improvement in mental and physical conditions . The general progress of medical science in all directions has been manifested in the department of psychiatry by improved methods of treatment, in the way of sleep-producing and alleviating drugs,
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dietetics, physical culture, hydrotherapy and the like . There are few asylums now without pathological and clinical laboratories . While it is a far cry from title prisons and monasteries of the past to the modern hospital for the insane, it is still possible to trace a resemblance in many of our older asylums to their ancient prototypes, particularly in those asylums built upon the so-called corridor plan .

Though each

generation contributed something new, antecedent
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models were more or less adhered to . Progress in asylum architecture has hence advanced more slowly in countries where monasteries and cloisters abounded than in countries where fixed models did not exist . Architects have had a freer hand in America,
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Australia and Germany, and even in Great Britain, than in the Catholic countries of Europe . Germany approaches nearest to an ideal standard of provision for the insane . The highest and best idea which has yet been attained is that of small hospitals for the acutely insane in all cities of more than 50,000 inhabitants, and of colonies for the chronic insane in the rural districts adjacent to centres of population . The psychopathic hospital in the city gives easy and speedy access to persons taken suddenly ill with mental disease,
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aids in early diagnosis, places the patients within reach of the best specialists in all departments of medicine, and associated, as it should be, with a medical school or university, affords facilities not otherwise available for scientific research and for instruction in an important branch of medical learning . A feature of the psychopathic hospital should be the reception of patients for a reasonable period of time, as sufferers from disease, without the formality of legal commitment papers . Such papers are naturally required for the detention and restraint of the insane for long periods of time, but in the earlier stages they should be spared the stigma, delay and complicated procedure of commitment for at least ten days or two weeks, since in that time many may convalesce or recover, and in this way escape the public record of their infirmities, unavoidable by present judicial procedures . There should be associated with such hospitals for the acutely insane in cities out-door departments or dispensaries, to which patients may be brought in still earlier stages of mental disorder, at a period when early diagnosis and preventive therapeutics may have their best opportunities to attain good results . In Germany a psychopathic hospital now exists in every university town, under the name of Psychiatrische xilinik . Colonies for the chronic insane are established in the country, but in the neighbourhood of the cities having psychopathic hospitals, to receive the overflow of the latter when the acute stage has passed . The true colony is constructed on the principle of a farming
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hamlet, without barracks, corridored buildings, or pavilions .

It is similar in most respects to any agricultural community . The question here is one of humane care and economical administration . Humane care includes medical supervision, agreeable home-life, recreation, and, above all things, regular manual and out-of-door occupation in

garden,
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farm and
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dairy, in the
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quarry, clay-pit or well-ventilated
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shop . Employment for the patients is of immense remedial importance, and of great value from the standpoint of economical administration . In the colony system the small cottage homes of the patients are grouped about the centres of industry . The workers in the farmstead live in small families about the farmstead
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group of buildings; the tillers of the
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soil adjacent to the fields, meadows and gardens; the .brickmakers, quarrymen and artizans in still other cottages in the neighbourhood of the scenes of their activities . In addition to these groups of cottages, which constitute the majority of the buildings in the village, an infirmary for bedridden, excited and crippled patients is required, and a small hospital for the sick . All the inhabitants of the colony are under medical supervision . A laboratory for scientific researches forms a highly important part of the equipment . The colony is not looked upon as a
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refuge for the incurable; it is still a hospital for the sick, where treatment is carried on under the most humane and most suitable conditions, and wherein the precentage of recoveries will be larger than in asylums and hospitals as now conducted . In respect of the establishment of colonies for the insane upon the plan outlined here, Germany has, as in the case of the psychopathic hospital, led the world . It has been less difficult for that country to set the example, because she had fewer of the conditions of the past to fight, and with her the progress of medical science and of methods of instruction in all departments of medicine has been more pronounced and rapid .

Among the German colonies for the insane, that at Alt-Scherbitz, near

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Leipzig, is the
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oldest and most successful, and is pre-eminent in its close approach to the ideal village or colony system . In 1899 Professor Kraeplin of
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Heidelberg stated (Psychiatric, 6th edition) that the effort was made everywhere in Germany to give the exterior of asylums, by segregation of the patients in separate home-like villas, rather the appearance of hamlets for working-people than prisons for the insane, and he said, further, that the whole question of the care of the insane had found solution in the colony system, the best and cheapest method of support . " I have myself," he writes, " had opportunity to see patients, who had lived for years in a large closed asylum, improve in the most extraordinary manner under the influence of the freer
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movement and more independent occupation of colony life." In America the colony scheme has been successfully adopted by the state of New York at the Craig Colony for Epileptics. at Sonyea and elsewhere . That the tendency nowadays, even outside of Germany, in the direction of the ideal standard of provision for the ihsane is a growing one is manifested in all countries by a gradual' disintegration of the former huge cloister-like abodes . More asylums are built on the
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pavilion plan . Many asylums have, as it were, thrown off detached cottages for the better care of certain patients . Some asylums have even established small agricultural colonies a few miles away from the parent plant, like a
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vine throwing out feelers . What is called the boarding-out system is an effort in a similar direction . Patients suffering from mild forms of insanity are boarded out in families in the country, either upon public or private charge . Gheel is an example of the boarding-out system practised on a large scale . But the ideal system is that of the psychopathic hospital and the colony for the insane .

End of Article: SENILE INSANITY
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SENIGALLIA, or SINIGAGLIA (anc. Sena Gallica)
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NASSAU WILLIAM SENIOR (1790-1864)

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