THE prevalence and treatment of insanity have been the subject of much consideration recently; but it appears from a letter by Prof. Clifford Allbutt in Wednesday's Times that though our system of public asylums is honourable and humane in intention, it is, in a scientific sense, a gigantic muddle. In fact, our management of insanity is, scientifically, a chaos. “Muddle!” In England, and in England alone, we muddle with complacency. Now to muddle is to labour with effects without regard to causes. Thus it is that we strive with the ‘unemployed’; thus that we strive with commercial incapacity; thus that we strive with educational failures, and so forth; ‘compromise’ being with us not the word for adaptations, but for supineness.... We pile up hospitals, sanatoriums, sick asylums, homes for incurables, colonies for epileptics and idiots, at vast cost direct and indirect, and wealthy persons make bequests, sometimes even liberal bequests, to such purposes; but what testator leaves money to an organisation of research by physicians and pathologists into the sources from which this frightful and manifold destruction pours forth with an absolutely, and perhaps with a relatively, augmenting volume? (I must not seem to forget the Lister Institute or recent gifts to the Cancer Fund; but of the general truth of my statement your own ieports of bequests from day to day are sufficient testimony.) No wonder that, thus ignorant but beginning to ‘ake up’ we run to the nearest plausible short cuts—to quackery and to hand-to-mouth remedies which are no remedies—rather than to the laborious investigation of origins and accelerations. If fifty years ago a tithe of the money expended upon the charities which are fighting at heavy odds with consequences had been spent upon knowledge, and this knowledge had been applied to prevention by a Ministry of Health instead of, as in its present imperfection, by a secondary department of some other office, by this time half of our expenditure on these melancholy results of our ignorance would have been saved, and the saving would be rapidly multiplying itself.” Prof. Allbutt urges that hospitals should be established for research into diseases of the nervous system, certain wards or wings being provided for the insane. The staff of a hospital of this kind should consist of young physicians, intellectually mature and highly and variously trained. Only when continuous and critical observations have been made under scientific conditions will it be possible to begin to create a classification of diseases of the nervous system by pathological affinity to qisplace the classifications which now are admirable only or chiefly for logical and metaphysical ingenuity.
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