Is it worth while to take the risk of trusting the doctors in order to gain the immense advantage of postponement of certification in those cases in which compulsory detention is manifestly a necessary condition of treatment? The Commissioners believe that it is, and have proposed that two separate ways of dealing with" the involuntary case" should be instituted. The first of these ways, and the new one, they call a provisional treatment order." This would be effective for one month, during which the patient might recover and be discharged or become a voluntary, uncertified boarder. But:

If the patient does not recover within that time the question of full certification will necessarily arise. We suggest, however, that if there is a prospect of the patient's recovery within a short time after the expiration of the initial period of one month he should have the advantage of further treatment without certification by an extension of the provisional treatment order. We therefore propose that, at the expiry of the first month, the order should be renewable for a further period of not more than five months.

This order, be it noted, is to be a judicial order. It is to have the force of law for two reasons, the chief of which is that it is a principle of English justice that the liberty of the subject may not be infringed without the intervention of some judicial authority. In other words the mentally sick person is to be placed under compulsory restraint, but is not to be certified as a lunatic. The restraint is to be imposed wholly and solely in the interest of the patient, and it will cease at once if and when it is no longer required. Certification becomes, in fact, a last resort, a confession of failure.

It is important to grasp this point. At present no doctor, when he signs a lunacy certificate, experiences any sense of failure. Why should he? He has just reached a diagnosis which satisfies his professional judgment, and he is in process of obtaining for his patient the necessary treatment. It will be quite different when the certificate means that the treatment given has been ineffective! Imagine the feelings of a doctor called upon to certify that he could not successfully treat a physical ailment, other cases of which had, notoriously, recovered.

For all practical purposes, if the recommendations of the Royal Commission are carried into effect, certification will cease to exist in its present form. No lunacy certificate, hereafter, will ever be quite free of the "stigma of ignorance." No doctor, and

especially no insanity specialist, will wish to sign more of those documents than he can possibly help. The dread of certification will thus weigh more heavily on the medical profession than on their patients. It will serve as a stimulus to research work, to study and to care in treatment. Thus, any danger which may be inherent in the loss of the safeguards now associated with certification will be fully compensated for by new safeguards of a much more satisfactory kind.

The doctor in fact will be only too anxious to observe any sign entitling him to hope for improvement. He will be reluctant even to resort to compulsion at all, since compulsion must rank, in the new order of things, as a step towards certification. The Commissioners, with very great foresight, have left the decision whether any given patient shall be regarded as a "voluntary or as an "involuntary" case to the doctor in attendance. As they say: "His (the doctor's) inclination will be to treat the case on the voluntary basis if he can."

His inclination will also be to prevent the case from becoming an involuntary one. He will have been brought to the position occupied by all those who treat physical ailments, and that by the simple expedient of thrusting certification into the outer darkness of "hopeless treatments."

Certification, however, is not the only obstacle which stands in the way of a public health view of insanity. There is also the Poor Law. The present legal status of the great bulk of insane persons in this country is that of paupers. They have become in law paupers because they have been overtaken by this particular form of illness, although they may never before have been in contact with the Poor Law.

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We desire," the Commissioners state, "to see the treatment of mental disease freed as far as possible from its present association with the Poor Law."

The way to do this is to associate lunacy administration with the general public health administration. The special provision already made for the treatment of infectious diseases, tuberculosis and venereal diseases, should, it is contended, afford some guidance in this matter. The Commissioners recommend that County Councils and County Borough Councils should be made responsible for providing accommodation and maintaining therein all persons in their area who, through mental disability, require

to be detained under care at the public expense. The cost of maintenance should be transferred from the poor rate to the county or borough rate. Orders for recovery of costs should be made by justices at Petty Sessions and should be such as the Bench deems equitable. Harmless senile cases might still, in some cases, be cared for in Poor Law institutions.

The local authorities, in other words, are to add the care of mental cases to their other health work. That they may exercise this care effectively they must, it is suggested, provide special accommodation for the temporary reception, observation and treatment of new cases under provisional treatment orders, and should be invested with new powers in relation to research, voluntary boarders, after-care and the appointment of certifying medical officers. It is added :—

In particular we recommend that they (the local authorities) should be empowered to provide clinics for out-patient and in-patient treatment of incipient cases of mental disorder. Our suggestions also contemplate the extended use by local authorities of existing powers in regard to improved accommodation for new cases in public mental hospitals, increase of medical staffs, developments in the nursing service, improvements in diet and more frequent provision of money allowances for patients on trial.

The local authorities will be assisted in this work by Exchequer grants, and it is proposed that these grants should be made available on conditions designed to ensure effective supervision by the Board of Control. This latter body will require new powers. At present it remains in loose association with the Ministry of Health; it is understaffed; its procedure is cumbersome. The Commissioners, nevertheless, believe that it has performed good work and they are convinced that it ought to continue as the central authority in all matters affecting mental care. They do not desire to see it merged in the Ministry of Health. On the other hand, they think that it is appropriate that the Minister of Health should be answerable for it to Parliament. This recommendation is in keeping with the general aim to associate the care of mental disease with that of physical disease, while at the same time making such special provisions as the nature of the special case demands. The Lord Chancellor's present jurisdiction over lunacy administration is not challenged by these suggestions, nor is it sought to challenge it. Every interference with the freedom of the subject presents a legal aspect and this cannot be overlooked.

Hence "the Master's Office " and the Lord Chancellor's Visitors will remain, for the present at least, though "there may be advantages in the ultimate amalgamation of the Chancery Visitors with the visiting staff of the Board of Control."

The Board of Control, as re-organized, should, it is held, be a smaller body than its predecessor. It should consist of a lay chairman, a legal commissioner, a medical commissioner, and a woman commissioner. There should be a visiting staff of at least 15 assistant commissioners on whom most of the visitation will devolve.

It can scarcely be doubted that, if these recommendations are carried into effect, an entirely new period in the care of mental sickness will begin. Mental sickness will be definitely and finally brought into association with physical sickness. There will be afforded an immediate and strong impulse to research, to study and to clinical observation. Moreover, hope will have been introduced as a new weapon of offence against despair and darkness. Further preventive medicine will have secured a place in lunacy practice, for early disease will be dealt with on an extensive scale, and local authorities will possess a direct interest in investigating the effects of any circumstances likely to conduce to mental breakdown, and in encouraging scientific research likely to throw fresh light on the causes of insanity. At the same time the sick person will be secured by all, or almost all, those safeguards which he now enjoys and he will possess new safeguards of an entirely different and much more effectual kind.

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MR. TREVELYAN'S HISTORY OF ENGLAND

History of England. By G. M. TREVELYAN. Longmans, Green. 1926.

MR.

R. George Macaulay Trevelyan won his great reputation and popularity as an historian by his brilliant studies of the Italian Risorgimento, perhaps the most romantic episode in the nineteenth century. His theory of historical writing is in one sense a return to earlier traditions. "Clio is a Muse"; in other words, poetry and imagination have their place in history, and must not be excluded from it. History is a science; but the sciences of inorganic and inanimate nature are no models for the delineator of human life, whether it be the life of individuals or of nations. Mr. Trevelyan would perhaps demur to the epigram that " history is the biography of ideals "; he prefers the description of events; but an event is in organic relationship with other events, and is linked with them by filaments which evade the chronicler of brute facts. Nor can history be worthily written unless the historian is able to feel the beauty and grandeur of some scenes, and the emotions which are the mainspring of what are now called movements. Mr. Trevelyan is assuredly right. Coldly scientific history is but the raw material for the epic which the history of a nation ought to be. Historical imagination is the art of seizing essentials and portraying them in living form.

Acting on this theory of the historian's task, Mr. Trevelyan gave us his enthralling narrative of Garibaldi and his time. But his own country has claimed him. His books on the Age of Wycliffe, on England under the Stuarts, on Lord Grey of the Reform Bill, on John Bright, and on England in the Nineteenth Century, have been followed (we may hope not concluded) by a masterly History of England in one volume, which is likely to supersede even so popular a work as the Shorter History of J. R. Green.

It is impossible not to compare Mr. Trevelyan's historical books with the famous History of England in the period of the Revolution (1688) by his great-uncle, Lord Macaulay, qui primus historiam ita scripsit ut vera fictis libentius legerentur. Macaulay also