SECTION ON MEDICAL JURISPRUDENCE.

REPORT OF CHAIRMAN.

J. R. NICHOLS, M. D.,

TERRELL, TEXAS,

First Assistant Physician, North Texas Hospital for the Insane.

"Medical Jurisprudence is a branch of jurisprudence that pertains to questions concerning wounds, poisons, insanity, and presumption of survivorship, requiring technical knowledge of the medical science for their elucidation and determination."

not my purpose to deal with the subject in its entirety, but will confine myself to that part pertaining to insanity; describing the methods of provision, management and treatment of mental diseases now adopted in this country.

It is necessary to refer to ancient methods in order to contrast the progress that has been made in this branch of science.

Past history of psychiatry up to the middle ages is known as the era of demoniacal exorcism. From this period up to and including the eighteeenth century is known as the chain and dungeon era, then follows the special asylums and hospitals, which continue to the present time with gradations of improvement to meet the existing conditions of scientific advancement.

AH alienists agree that the earlier insanity is recognized and given the proper treatment, the more favorable is the prognosis, therefore the most modern method is the establishment of psychopathic hospitals for immediate provision and treatment, obviating the delay incidental to admitting the patient to the eleemosynary institutions for the insane.

This method is of prime importance to the patient and a source of comfort to those immediately interested, besides it would not be

necessary to provide custodial care in prisons, a custom which needs only to be mentioned to be condemned.

After a certain period of time, the stationary and unimproved cases in these psychopathic hospitals are adjudged of unsound mind and committed to the regular hospitals for the insane.

Germany is taking front rank in constructing these institutions, having them in all the large cities; they are managed and equipped similarly to our general charity hospitals.

Alienists and students of mental diseases substitute the terms "hospitals" and "mentally diseased" for "lunatic asylums" and "crazy." These latter designations are harsh and frequently produce a deleterious moral effect on the sensitive patient. The laity are uneducated to the fact that insanity is not a disgrace, and so long as they persist in stigmatizing the mentally afflicted, so will the restorations be diminished. The frequent recurrence of mental disease is largely due to the want of confidence that the restored patient encounters, which humiliation revives the exciting cause.

At the close of the nineteenth century we have special institutions for the insane, epileptic, criminal insane, inebriates and mental defectives such as idiots, imbeciles and feeble minded.

The methods of provision have undergone a decided change and the block of concrete system of buildings is being superseded by the cottage plan, which is a more home like environment for the patient, whereas the block system is too sudden a departure from domestic life to be conducive to real comfort and happiness.

All observers agree that more good is accomplished by moral agencies in the treatment of mental diseases than by medicinal. agents, therefore the patient should be placed in the most suitable. environment; home like, sociable, with orderly and friendly associates. The psychical impression made upon an individual in a confused mental state is quite a factor in the ultimate prognosis and no expense should be spared in constructing our State hospitals with all the modern appointments. I heartily endorse the cottage system as the most feasible plan of provision for the mentally diseased; it offers many advantages over the block system:

First, is classification which insures happiness and contentment, a condition which aids materially the prognosis.

Second, an ideal hygienic system is secured.

Third, isolation of infectious and communicable diseases. Fourth, danger of fire is very much reduced and the entire institution is not exposed, a condition that is a source of much anxiety in the block system, where hundreds of patients are housed under one roof; and

Fifth, the cost of construction, maintenance and repairs is not any more than that of the block system.

The physical management of our hospitals for the insane and the scientific treatment of mentally diseased and mental defectives have made wonderful progress in the United States, surpassing similar institutions in Europe, but there is a deficiency in original research from a pathological standpoint which is made a special department of study in the foreign hospitals, whereas only a small number of our institutions have well equipped pathological laboratories; however, this department is recognized as an important adjunct and it is only a question of time when the others will fall in line.

Many of ous State hospitals have a well organized staff of physicians and surgeons who are enthusiastic in this branch of science, not so much for the remuneration they receive as from patriotic and charitable feelings toward their fellow man.

The moral influence that encouraging words, patience and diplomacy exerts, is of the greatest importance in the treatment, and it can only be acquired by long experience and special study of each case. Another commendable feature is regular staff meetings, the object and purpose being to present papers and cases which are discussed; there is no question that such meetings act as a stimulus and each member of the staff will naturally put forth his best efforts.

I will briefly outline what constitutes the accepted methods in this country for the public care and treatment of mental diseases from an eleemosynary basis. The location of an institution of this

kind is of special importance to the public and State; a site should be selected near the center of a given population, easily accessible from all directions by adequate railroad facilities; there should be at least one tillable acre of land to each patient, and the capacity of the institution should not exceed twelve hundred beds.

The surroundings should be hygienic, a natural drainage, uncontaminated atmosphere, and an inexhaustible supply of pure water. An abundance of native shade trees adjacent to the building site will save expense and provide shade for the patients, visitors and employes. A gravel pit on the premises will insure good walks and roads at a minimum cost.

The institution should be constructed on the cottage plan with all the modern appointments and entrusted to the management of a wide awake, energetic superintendent endowed with recognized executive ability and scientific knowledge; he should surround himself with enthusiastic, educated and conscientious medical assistants, loyal in every respect, and select competent heads for the other departments.

A pathological laboratory should be established, original research encouraged and regular staff meetings held at stated intervals, where papers and questions beneficial to the institution should be discussed.

There should be a well equipped operating room, constructed and arranged similar to those in our general charity hospitals, where aseptic surgery can be done according to modern methods. Electro and hydrotherapeutic apparatus should be installed as important adjuncts to the hospital equipment.

Trained attendants are much superior in every way to the inexperienced, therefore training schools should be established with a two years course for graduation, the didactic and clinical lectures to be delivered by the hospital staff, assisted by experienced graduated tutors who should instruct in the practical duties on the ward and at the bedside.

Diversion is an important adjunct in producing contentment and mental rest, as idleness breeds discord. Patients are encour

aged to take exercise, as daily recreation in the park, and assist with the work in the different departments of the institution, but no drastic measures are permitted to coerce them; the general experience of observers both in this country and in Europe is, that properly selected employment for each patient is of great value in the treatment and this systematic employment is profitable to the institution.

All of those who are physically able and understand in a measure the import of the duties assigned are permitted to employ themselves. They assist in the general housekeeping of the ward, and many of the females become quite proficient in mending, knitting, hemstitching, crochet and drawn work.

The different departments have their regular quota of patients, as the laundry, sewing room, kitchen, barns, mattress shop, farm, grounds, store room, plastering, painting, plumbing, dairy, garden, tailoring, dining room, and emergencies that come up from time to time. Precaution is taken at all times to prevent over exertion on the part of anyone.

The average amount of labor done by a patient is estimated as being about one-fourth of that of a sane person under the same conditions and circumstances.

Various amusements receive special attention and many of our State hospitals have a well organized orchestra to furnish music, which Abbott says is the only "perfect language of the higher emotions."

Games, both indoor and outdoor, as cards, billiards, pool, dominoes, checkers, chess, lawn tennis, baseball, football and other field sports have their place in the treatment of mental diseases.

Literature is provided, as books, periodicals and newspapers, which furnish a mental stimulus and is the means of whiling away the time and the lonesome feeling that idleness courts. Also the regular dances, which permit the males and females to mingle with each other and is a source of especial enjoyment to them. Other diversions, as band concerts, matinees, concerts, carriage drives, picnicking, fishing parties, gymnasium, bowling alleys and swim