to the position of medical examiners in lunacy. But before accepting these responsible positions, they should be compelled to fit themselves for their delicate and trying duties by a course of special study in mental and nervous diseases. All legally incorporated colleges should favor their students with an adequate course of lectures on these subjects. 2. Physicians should be authorized to act as medical examiners only after they have been in actual practice for at least seven years. Pythagoras required of his pupils the study of a question in philosophy for seven years before he permitted them to express an opinion. And in the commitment of the insane, as much preparation should be required of medical examiners, by study and by the acquirement of a practical knowledge of insanity through practice and experience, as the great philosopher required in the expression of opinions upon abstract subjects. 3. Before a physician is commissioned, as a medical examiner in lunacy, he should appear before a judge of a court of record and develop the fact that he is possessed of the qualifications required in the preceding sections. 4. When a duly qualified medical examiner in lunacy makes a certificate, in a given case of insanity, he should not only swear to that certificate, but he should incorporate such a number of plain and palpable evidences of insanity as will enable the judge to not only approve it, but, upon such evidence, the judge should be enabled to grant a judicial order of commitment. 5. Each judge of a court of record should be compelled to examine carefully the evidences of insanity recorded in all certificates presented to him, and if satisfied with such evidence, he should then be required to give an order of commitment in each case; and if not satisfied, he should either summon before him the physicians making out the certificates, for further examination, or call a jury to decide the case, in his discretion. 6. After a patient has been examined, and the certificate of lunacy prepared by two physicians, and a judicial order has been issued by a judge of a court of record, upon the evidence in such certificate, at least fifteen days' time should be granted in which to secure said patient's admission to an asylum. 7. If it is necessary, in an emergency, to send a patient to an asylum immediately after he has been examined by two physicians, and before a judge's order has been obtained, then fifteen days' time should be allowed the judge to examine the evidence given by the physicians before he makes his final order of commitment. And it should be made legal and proper for the authorities of an asylum to receive and care for an excited case, in an emergency, for fifteen days before receiving the order of commitment from a judge of a court of record. 8. In addition to the present facilities for discharging patients after recovery there should be a board of lunacy commissioners empowered to examine all convalescent cases at least twice a year, and confer with the superintendent and unite with him in the responsibilities of discharging all who may have recovered. This board of commissioners should be composed of men who have had actual experience in caring for the insane in asylums, and who have, consequently, enjoyed abundant opportunity for the study and understanding of insanity. 9. The law should empower the superintendent of an asylum more specifically than it now does with the right to parole patients, and allow them to leave the asylum in charge of their friends for any term that he may deem expedient, granting also to the friends the privilege of returning such paroled patients in case of relapse at any stated period ranging from one month to one year. By the aforenamed measures the commitment of insane persons to asylums would be continued upon a medical basis and yet these commitments would be guarded by every needful judicial care and requirement. The sending of an insane person to an asylum during the early portion of his disease should be made as easy as possible ; and yet such disposal of a patient should be made consistent with the vested rights to life, liberty and happiness of the individual citizen. A ready facility for commiting patients to asylums for hospital treatment should be had in order that cures in the early stages of insanity may be effected in the largest possible number of cases. After commitment the patient should be examined at stated intervals by impartial and specially skilled examiners, and they should be discharged or paroled as quickly as the interest of the patient and the safety of the community will admit. By adopting such measures notable progress in the line of reform will be attained, and at the same time the rights of those who are sick in mind and the interests of the community and society will be most surely conserved. In our care and treatment of the insane as in all matters pertaining to the general interest of the State and its citizens we should endeavor to attain the greatest good, both for the individual and for the masses. In enforcing the seclusion of the insane and in placing them under wise, humane and successful treatment as promptly as possible after mental maladies have invaded the citadel of health, we are simply performing necessary and Christian duties. When valuable lives and great social interests are at stake, we should always remember that "delays are dangerous." And we should likewise remember that prompt action in all emergencies of mental or zymotic disease is one of the most urgent and imperative of public duties. In the performance of such duties we should seek to execute even-handed justice, and likewise we should bear in mind that justice should always be tempered with that Divine mercy which sanctifies and enshrines "The throned monarch better than his crown, With the invited co-operation of Dr. W. J. MARTIN, Pittsburg, Pa. A CASE OF POISONING BY AN EXCESSIVE AMOUNT OF ARSENIC. BY C. E. VAN CLEEF, M. D., The case detailed in this paper presents a few points of interest which may be noted as follows: The amount of Arsenic taken, the prolonged period of quiescence after taking, the long interval before the discovery of the fact that poison had been taken and finally, the recovery of the patient. Case Record: Called during the morning of June 19, 1885, to see Mrs. C., aged 24 years. Found her with obstinate retching and vomiting of yellowish, slimy mucous; pulse 100, pulsating headache through the temples. Vomiting had continued throughout the latter part of the previous night. Suspected poisoning and asked whether there was *Semi-Annual. any burning in the stomach. Patient answered "No." Not having any direct evidence of poisoning, prescribed symptomatically and left patient with the promise to return shortly. A little later found patient very much worse, restless, anxious, with severe frontal headache and continuous nausea and vomiting. In her agony the patient now confessed to having severe burning and shooting pains in the stomach and said that during the previous afternoon and evening, with suicidal intent, she had taken dry, in three doses, two-thirds of the contents of a package containing one and one-half drachms of Arsenious acid in powder. The first powder was taken dry at 4 P. M., the second at 6 P. M., and the third at 9 P. M. Immediately I gave six ounces of Olive oil and Lime water in equal parts. In about fifteen minutes this was ejected. Then gave about the same quantity of Castor oil and Lime water in the same proportions. This was also largely ejected. Then gave whites of four eggs, four ounces of milk and one of Lime water, which mixture immediately removed the sense of intense burning in the throat and oesophagus, of which she complained on taking the Oil nd Lime water. Though the nausea remained the vomiting was much less frequent, pulse 125. At intervals of three hours, the mixture of whites of eggs, milk and Lime water was ordered repeated throughout the evening and till otherwise directed. Dialysed iron was prescribed at intervals of three hours in doses of forty drops. 11 P. M. All symptoms more favorable, pulse 110. June 20th, 10 a. m. Pulse 108. Nausea not so continuous and vomiting almost entirely stopped. There is very little burning in the stomach, though there are occasional shooting pains through the stomach and abdomen. Pressure upon stomach produces nausea. The whites of three eggs instead of four are now given with four ounces of milk and one of Lime water. Dialysed iron is discontinued. There are occasional eructations of gas with less frequent griping pains in the bowels. Has had two small movements of dark liquid material without burning at anus. 2 P. M. Pulse 125. Patient is very much prostrated. Complains of occasional shooting and griping pains in abdomen. Continue the milk mixture as before. 10 P. M. Patient has had a movement with burning at the anus. There is a more frequent desire for stool but with no result. June 21st, 10 A. M. Pulse 105. Much stronger. Rested well last night. Has occasional griping pains but less fever than yesterday P. M. Complains of aching all over. Has bad taste in mouth. Tongue feels thick, has a dirty white thin coat is middle with red sides and tip. |