DEMENTIA OR FATUITY

Dementia consists in a failure of the mental faculties, not congenital, but coming on during life. “A man,” says Esquirol, “in a state of dementia is deprived of advantages which he formerly enjoyed. He was a rich man who has become poor. The idiot, on the contrary, has always been in a state of want and misery.” In this state there is always more or less coherence, and maniacal paroxysms are not infrequent. In mania, incoherence may be present, but then it is characterised by sustained and violent excitement. In dementia, on the other hand, there is apparent torpor and exhaustion of the mental faculties. Closely allied to this form of mental unsoundness is that interesting disease known as “general paralysis of the insane,” or perhaps a better term, progressive paralysis of the insane. It is considered by some to precede the psychical derangement, a contrary opinion being held by others. General paralysis may accompany any of the forms of mental derangement, but it is generally preceded by a stage of melancholy. As the paralytic affection becomes more marked, there is a concurrent loss of memory and incapability of mental association, and all sense of duty is lost; the patient becomes careless as to his person, and dirty in his habits. He expresses himself as possessed of great property, and boasts of the wonderful deeds that he can or has accomplished. Gradually he sinks into a state of complete mental and physical decay. He cannot give expression to his thoughts, and has to be fed, the food being pushed into his mouth. The symptom which first attracts the attention, and which is perhaps the first order of sequence, is a modification in the articulation. “This is neither stammering nor hesitation of speech. It more closely resembles the thickness of speech observable in a drunken man. It depends upon loss of power over the co-ordinate action of the muscles of vocal articulation.” If the tongue be now examined, it will be found that when it is protruded it is not inclined to one side, but that it is tremulous, and is protruded and withdrawn in a convulsive manner. Griesinger was the first to call attention to the fact, and his statement has since been confirmed, “that this motory disorder is at the commencement not so much paralytic as convulsive in its nature.” The gait becomes unsteady, the patient walks stiffly, and stumbles over the slightest unevenness in the floor. Step by step the paralysis progresses, till at last the unfortunate sufferer takes to his bed, on which he may lie for months. Sometimes, especially during the earlier stages, he may suffer from terrible delusions, from maniacal paroxysms, or from epileptic fits, the latter possessing certain peculiarities. The tongue during the fit is seldom bitten, which is so commonly the case in epilepsy; and the convulsions are not so general, being limited more to one side than to the other. It is also remarkable that each fit is in most cases followed by an increase of the mental derangement.

Pritchard recognises four stages of dementia or fatuity:—

First Stage.—Forgetfulness and impaired memory. This is common to old age. In most cases passing events produce little, if any, impression, whilst the past is remembered with tolerable freshness.

Second Stage.—Incoherence and unreason, characterised by a total loss of the reasoning faculty.

Third Stage.—Incomprehension. The person so affected is quite incapable of comprehending the meaning of the simplest question; and should he attempt to reply, his answer is generally remote from the subject.

Fourth Stage.—Inappetency. The animal instincts are lost. The unfortunate sufferer lives, and that is all, being scarcely conscious of life. Organic life is all that is left.

DELIRIUM TREMENS. SIMPLE DELIRIUM.
SOMNAMBULISM. SLEEP-DRUNKENNESS.

Delirium Tremens.—A temporary form of insanity, the result of excessive indulgence in spirituous liquors. The drunkard, under the effects of intoxication, “can derive no privilege from a madness voluntarily contracted, but is answerable to the law equally as if he had been in full possession of his faculties at the time” (1 Hale 32; Co. Litt. 247). The intoxication of the defendant may be taken as a mitigating circumstance, showing that the deed was unpremeditated. A person rendered incapable of using his reason by intoxication brought about by others, is not liable for his actions.

Simple Delirium.—Acts performed during attacks of certain diseases—fever, sunstroke, &c.—accompanied with delirium, do not render the individual liable to punishment; and wills made during the continuance of the disorder, if they contain no statement inconsistent with the known wishes and desires of the party during health, are valid, the law looking more to the good sense of the will as a proof of a lucid interval, than to the proved existence of such lucid interval.

Somnambulist, &c.—This is an abnormal mental state, closely allied to that artificially produced and known under the names of mesmerism, hypnotism, electro-biology, &c. It is commonly known as “sleep-walking.” In this condition the mind appears to become enslaved by one train of ideas to the exclusion of all others; the somnambulist, thus deeply bent on the accomplishment of a definite end, takes no heed of those objects which are in no way connected with the dominant ideas in his mind. Hence, he walks safely past dangers which, when awake, would disconcert his judgment and weaken his will. Somnambulism appears also to be closely connected with epilepsy. In 1878, a man named Fraser was tried in Glasgow for the murder of his child by beating it against the wall. He was acquitted on the ground of being unconscious of the nature of his act by reason of somnambulism. He had sprung from an epileptic and insane stock; his mother died in an epileptic fit, and some of his other relatives were insane. Thus it appears, if the somnambulism be proved, the accused is exonerated from any responsibility connected with the act for which he is being tried. So also, if a person be suddenly aroused from a deep sleep—somnolentia or sleep-drunkenness—the question may be raised as to his responsibility for an act committed at the moment of awakening (R. v. Milligan). There cannot be a doubt but that if a person be suddenly aroused whilst dreaming, he may unconsciously commit acts, the outcome of his dream, which, unless the possibility of this condition be recognised, may entail severe punishment on him. This state is closely allied to that mental condition which sometimes occurs in epileptics immediately after a fit. But in this, as in cases of somnambulism, the facts of the case would have to be most carefully scrutinised.

The following hints may be of use as a guide in determining the responsibility or not of the accused:—

1. The person must be shown to have a general tendency to deep and heavy sleep, out of which he can only be aroused by a violent and convulsive effort.

2. Are there any circumstances which, happening before the individual went to sleep, would produce a train of disturbed thought not entirely composed by sleep?

3. Did the act occur during the usual hours for sleep?

4. Was the cause of the awakening sudden, and does the act bear throughout the character of unconsciousness?

5. What were the subsequent acts of the accused in relation to the deed? Did he try to evade responsibility? This must not have too much stress laid upon it, for the wretchedness of the sudden discovery may so overcome him, that he may seek to shelter himself from the consequences of an act for which he is legally but not morally responsible.

THE RESTRAINT OF THE INSANE
AND DIRECTIONS FOR SIGNING
MEDICAL CERTIFICATES.

No person can be put under restraint unless the conditions required by the Lunacy Acts are fulfilled. The Acts of Parliament for this purpose are the Lunacy Act of 1890 (53 Vict. c. 53) and that of 1891 (54 and 55 Vict. c. 65). Lunatics may be put under restraint by the following procedures, according to the particular case:—

Reception Order on Petition.
Urgency Order.
Order after Inquisition.
Summary Reception Order.
Order for Lunatics Wandering at Large, and for Pauper Lunatics.
Reception Order by Two Commissioners.

Reception Order on Petition.—This is usually the procedure for private patients. The order for petition may be obtained from a specially appointed Justice of the Peace, Judge of County Courts, or Magistrate. A petition for the order must be presented to the Judicial Authority by the husband, wife, or relative of the alleged lunatic; if any other person apply, the reasons for this must be given. A petitioner must be twenty-one years of age or over, and must have seen the alleged lunatic within fourteen days before its presentation. A statement of particulars and two medical certificates must accompany the petition. The proceedings are private, and no one except the petitioner, the alleged lunatic, and any one person appointed by him, and the two medical men who have signed the certificates, may be present, unless by permission of the Judicial Authority. If the Judicial Authority be satisfied, he may make the order at once, even without seeing the patient, or he may appoint a time within seven days for inquiries and consideration. He may visit the alleged lunatic.

At the time of consideration of the petition he may adjourn it for not more than fourteen days, or he may make the order at the time. He may summon further witnesses, or dismiss the petition, giving his reasons for so doing in writing.

A reception order is valid for seven days from its date, unless the lunatic is certified by a medical man to be unfit for removal, when the order is extended until a medical certificate of fitness for removal is obtained, which is valid for three days.

The medical men signing the certificates must not be in partnership, as principal and assistant, or have any direct or indirect interest in the patient or his keeping (16 and 17 Vict. c. 96, sec. 4). They must make separate visits at different times for the purpose of examination. Each medical man must have examined the person within seven clear days before the presentation of the petition.

Each medical man must write clearly and in the proper place on the certificate: (1) The facts observed by himself as evidence of insanity, and (2) the facts observed by others as evidence of insanity. The name of his informant must be given.

One of the certificates should, whenever practicable, be under the hand of the usual medical attendant (if any) of the alleged lunatic. If not practicable, the reason must be given by the petitioner to the Judicial Authority.

Neither of the certifying medical practitioners may be the father or father-in-law, brother or brother-in-law, sister or sister-in-law, partner or assistant of the other of them.

Great care should be taken to follow carefully the marginal directions on the certificate form. The most trivial omission will invalidate the certificate. The omission of the name of the street and number of the house is sufficient to set it aside. A medical man should remember that, although his certificate may have passed the scrutiny of the Commissioners, it is liable to be made the subject of discussion in a Court of law, and in cross-examination he will have to support the statements therein made.

The following certificate properly filled up by Dr. Millar of Bethnal House Asylum, is given in his book on Hints on Insanity, and may be taken as an example of a correct certificate at that time, the present form being slightly different:—

MEDICAL CERTIFICATE
PROPERLY FILLED UP

1. Here set forth the	I, the undersigned,
qualification entitling the	John Millar, being a (¹)
person certifying to practise	Licentiate of the
as a physician, surgeon, or	Royal College of Physicians,
apothecary.	Edinburgh,
	and being in actual practice as
2. Physician, surgeon, or	a (²) Physician, hereby certify
apothecary, as the case	that I, on the third day of
may be.	November, One thousand eight
	hundred and eighty-eight_, a
3. Here insert the street and	(³) 600 - Cambridge Road,
number of the house (if	Bethnal Green, in the county of
any), or other like particular.	Middlesex, separately from any
	other medical practitioner,
	personally examined
	James Thompson, sen., of
4. Insert residence, and	(⁴) 600 Cambridge Road,
profession or occupation	Bethnal Green, gentleman,
(if any).	and that the said James Thompson,
	sen., is a person (⁵)
5. Lunatic, or an idiot,	of unsound mind, and a proper
or a person of unsound mind.	person to be taken charge of, and
	detained under care and treatment;
	and that I have formed this opinion
	upon the following grounds, viz.:—
6. Here state the facts.	1. Facts indicating insanity
	observed by myself (⁶)—
	He is incoherent in his
	conversation, violent in his
	conduct, and quite unable to
	take care of himself.
7. Here state the information,	2. Other facts (if any)
and from whom.	indicating insanity
	communicated to me by
	others (⁷)—

	His son, James Thompson, jun.,
	informs me that he has
	threatened to commit suicide,
	and has twice attempted it with
	a razor.

	(Signed) Name—JOHN MILLAR

Place of abode—Bethnal House, Bethnal Green.
Dated this third day of November, One thousand eight hundred and eighty-eight.

Table relating to “Facts” of Insanity,

(compiled from Millar.)

Facts offering no Evidence
of Insanity.

1. Refuses to take her medicine and resists

in every way; closes her teeth; threatens

to strike every one near her; obliged to

use the strait-waistcoat.

2. Violent in her temper, and very abusive.

3. Moody and irritable temperament, and of

weak memory in many particulars.

4. General restlessness of manner; considers

himself heavily involved in debt to many

thousand pounds; says he has been ruined

by the Government, and that he intends

prosecuting the Admiralty for £5000 damages.

Vague and Irrelevant Facts.

1. She is suspicious of her husband; says he

keeps bad company; she is most irritable and

jealous, and takes stimulating drinks to a

dangerous and exciting extent.

2. Obstinate; has the manner and appearance

of an insane person; complained of her head;

refused her food, and would not go

downstairs; melancholy.

3. He has imperfect sight; good hearing and

taste; he is unable to speak; his gait is

ape-like, and the skull-bones seem to have

fallen together from the want of cerebral

development. He will occasionally slap his

face and strike his hands; sometimes makes

a howling noise.

4. She is very good-tempered; but day and

night she talks almost incessantly;

occasionally sings. She says she comes from

Otaheite, and relates stories of thos

around her doing absurd things.

Good Facts.

1. She states that she is a lost person and

without hope of forgiveness; that she will

be taken to prison, and die a miserable

death; that the devil whispers in her ear

that she has committed the unpardonable sin.

2. Great taciturnity; complete seclusion

from society; aversion to cleanliness;

wandering about the streets at improper hours.

3. He states that he is a Prince of France;

that he possesses a palace, and has recently

had two fortunes left him (he cannot tell by

whom)—one of £400,000, the other of

£600,000; that he is going to Liverpool, a

distance of 150 miles, with a horse and

cart, which will take him four hours to go and

eight to return.

4. Inability to hold any rational

conversation; her manner and conduct are

totally at variance with her usual habits.

The following are examples of “Facts” sent back to be amended by the Commissioners—the emendations in italics:—

1. Incoherence, perversion of facts, delusion. Fancies that he possesses large amounts of money which people have secreted from him.

2. Says her sister lives in Chiselhurst, and she fears she is dying. She took great notice of my feet, and remarked that they were very large. Query by Commissioner—Are these delusions? Her sister does not live at Chiselhurst, and is perfectly well; my feet are not large.

3. General restlessness of manner; considers himself heavily involved in debt to many thousands of pounds, whereas his debts do not amount to a few hundreds; says he has been ruined by the Government, whereas he has only been dismissed from his appointment on account of his incapacity; and he intends prosecuting the Admiralty for £5000 damages, he having no real ground of action. (This was twice sent back for correction, the first correction being—By these statements I was satisfied that the patient was of unsound mind, and by his general conduct during examination. Finally amended as given above.)

(a)—a Justice of the Peace for ____, or His Honour the Judge of the County Court of ____, or ____ Stipendiary Magistrate for ____.

(b) Full postal address and rank, profession, or occupation.

(g) Some day within 14 days before the date of the presentation of the petition.

(h) Here state the connection or relationship with the patient.

(k) Full Christian and surname.

53 Vict. c. 5.—Sched. 2, Form 1.

PETITION FOR AN ORDER FOR RECEPTION
OF A PRIVATE PATIENT

In the Matter of_______________________________
a person alleged to be of unsound mind.

To (a)____________________________________

____________________________________

The Petition of__________________________________________

of (b)______________________________________________

______________________________________________

in the County of_________________________________________

1. I am___________(c) years of age.

2. I desire to obtain an Order for the Reception of

________________________________________________

as a person of unsound mind, in the Haydock Lodge Licensed House,
situate at Newton-le-Willows, Lancashire.

3. I last saw the said__________________________________

at______________________________________________________

on the (g)_______day of________________ 19_______

4. I am (h)_______________________________ of the
said________________________________________________

(or if the Petitioner is not connected with or related
to the or Patient, state as follows:)

I am not related to or connected with the said_________________
________________________________________________________

The reasons why this Petition is not presented by a relation
or connection are as follows:

The circumstances under which this Petition is presented by
me are as follows:—

5. I am not related to or connected with either of the persons
signing the certificates which accompany this petition as (where
the petitioner is a man) husband, father, father-in-law, son,
son-in-law, brother, brother-in-law, partner, or assistant (or
where the petitioner is a woman) wife, mother, mother-in-law,
daughter, daughter-in-law, sister, sister-in-law, partner, or assistant.

6. I undertake to visit the said_____________________________
__________________________personally, or by some one specially
appointed by me, at least once in every six months while under
care and treatment under the order to be made on this petition.

7. A statement of particulars relating to the said________________
______________________________________accompanies this petition.

If it is the fact, add: 8. The said_____________________
has been received in the Haydock Lodge Licensed House,
Newton-le-Willows, under an Urgency Order dated the____________
________________________________________________________

The petitioner therefore prays that an order may be made in
accordance with the foregoing statement.

Signed (k)_______________________________________

Date of Presentation of the Petition, this____________

day of___________________ 19_________

53 Vict. c. 5, s. 31.

When neither Certificate is signed by the
Usual Medical Attendant.

(a) Name
of
Patient.

I, the undersigned, hereby state that it is not practicable to
obtain a Certificate from the usual Medical attendant of (a)
__________________________________________________________________
for the following reason, viz.:—

(b) To be
signed
by the
petitioner.

(Signed) (b)______________________________

_______________ 19____________

Form 2.

STATEMENT OF PARTICULARS REFERRED
TO IN THE ANNEXED PETITION

If any particulars are not known the fact is to be so stated.

[Where the patient is in the petition or order described
as an idiot, omit the particulars marked ►]

The following is a Statement of Particulars		__________________
relating to the said		__________________

Name of patient, with Christian name at		__________________
length		__________________

Sex and Age		__________________
► Married, single, or widowed		__________________

► Rank, profession, or previous occupation		__________________
(if any)		__________________

► Religious persuasion		__________________

Residence at or immediately previous to		__________________
the date hereof		__________________

► Whether first attack		__________________
Age on first attack		__________________

When and where previously under care		__________________
and treatment as a lunatic, idiot, or		__________________
person of unsound mind		__________________

► Duration of existing attack		__________________
Supposed cause		__________________
Whether subject to epilepsy		__________________
Whether suicidal		__________________
Whether dangerous to others, and in		__________________
what way		__________________

Whether any near relative has been		__________________
afflicted with insanity		__________________

Names, Christian names, and full postal		__________________
addresses, of one or more relatives		__________________
of the patient		__________________

Name of the person to whom notice of		__________________
death to be sent, and full postal		__________________
address, if not already given		__________________

‡Name and full Postal Address of the		__________________
usual Medical Attendant of the Patient		__________________

‡When the Certificate is not signed by the usual Medical Attendant, the Certificate on the other side must be filled out.

(a) When the
petitioner
or person
signing an
urgency order
is not the
person who
signs the
statement, add
the following
particulars
concerning
the person who
signs the
statement.

Signed (a)
Name, with Christian
Name at length	____________________________________
Rank, Profession or
Occupation (if any)	____________________________________
How related to, or
otherwise connected
with the Patient	____________________________________

53 Vict. c. 5. s. 7 (4).

When a previous Petition has been dismissed.

(a) Name of
Patient.

(b) Name
of asylum,
hospital,
licensed
house,
or single
charge.

I, the undersigned, hereby state that a former Petition for

Reception of (a)___________________________________________

into (b)__________________________________________________

was presented to __________________________________________

(c)______________________________________________________

in the month of________________ 19_______, and dismissed.

Herewith is a copy
(furnished by the Commissioners in Lunacy)
of the statement sent to them of the reasons for its dismissal.

Signed________________________________________
________________ 19________

Note.—This Copy is to be obtained from the Commissioners
in Lunacy by the Petitioner at his own expense.

An Order for Reception of a Lunatic is to be obtained upon a private application by Petition to a Judge of County Courts, or Stipendiary Magistrate, or Metropolitan Police Magistrate, or specially appointed Justice of the Peace. The petition is to be presented, if possible, by the husband or wife, or by a relative (i.e. a lineal ancestor or lineal descendant, or lineal descendant of an ancestor not more remote than great-grandfather or great-grandmother) of the Lunatic, and is to be accompanied by a Statement of Particulars and two Medical Certificates on separate sheets of paper. One of the Medical Certificates accompanying the Petition must, if practicable, be by the usual Medical Attendant of the Lunatic; if not by him, the reason must be stated ([see Form above]). If a previous Petition has at any time been dismissed, the facts relating to its dismissal are to be stated in the fresh Petition ([see Form above]); and the Petitioner must obtain from the Commissioners in Lunacy a Copy of the Statement sent to them of the reasons for its dismissal, and present this copy with his Petition. The Reception Order (which will not remain in force for more than seven days after its date), the Petition, the Statement of Particulars, and the Medical Certificates must be sent to the Superintendent or Proprietor of the Asylum, Hospital, or House where the Patient is to be received.

(a) Insert residence of patient.

(b) County, city, or borough, as the case may be.

53 Vict. c. 5.—Sched. 2, Form 8.

CERTIFICATE OF MEDICAL PRACTITIONER

In the Matter of_________________________________________

of (a)___________________________________________________

in the (b)_____________________ of_________________________

_______________________________________an alleged lunatic.

I, the undersigned, ________________________________________
do hereby certify as follows:

1. I am a person registered under the Medical Act, 1858,
and I am in the actual practice of the medical profession.

(d) Insert the place of examination, giving the name of the street with number or name of house, or should there be no number, the Christian and surname of occupier.

(e) County, city, or borough, as the case may be.

(f) Omit this where only one certificate is required.

(g) A lunatic or an idiot, or a person of unsound mind.

(h) If the same or other facts were observed previous to the time of the examination, the certifier is at liberty to subjoin them in a separate paragraph.

(i) The names and Christian names (if known) of informants to be given, with their addresses and descriptions.

(k) Strike out this clause in case of a patient whose removal is not proposed.

(l) Insert full postal address.

2. On the_______________________ day of ________________ 19__

at (d) _______________________________________________

in the (e)___________________ of _____________________

_________________(separately from any other practitioner) (f)

I personally examined the said ___________________________________

and came to the conclusion that ____ he is (g) ____________

and a proper person to be taken charge of and detained under

care and treatment.

3. I formed this conclusion on the following grounds, viz.:—

(a) Facts indicating insanity observed by myself at the

time of examination (h), viz.:—

_____________________________________________________________

(b) Facts communicated by others (i), viz.:

_____________________________________________________________

4. The said __________________________________________________

appeared to me to be[18] ..................in a fit condition of

bodily health to be removed to an asylum, hospital, or licensed house (k).

5. I give this certificate having first read the section of the

Act of Parliament printed below.

Signed____________________________________
of (l)_____________________________

Dated this __________ day of ________ 19__

Lunacy 8.

53 Vict. c. 5, ss. 4, 11, 16, 28, 29.

Extract from section 317 of the Lunacy Act, 1890.

Any person who makes a wilful misstatement of any material
fact in any medical or other certificate or in any statement or
report of bodily or mental condition under this Act, shall be
guilty of a misdemeanour.

(a) A Justice for —, specially appointed under the Lunacy Act, 1890, or the Judge of the County Court of —, or the Stipendiary Magistrate for—

(b) Address and occupation.

(d) Name of petitioner.

53 Vict. c. 5.—Sched. 2, Form 3.

ORDER FOR RECEPTION OF A PRIVATE PATIENT, TO BE MADE
BY A JUSTICE APPOINTED UNDER THE LUNACY ACT, 1890,
JUDGE OF COUNTY COURTS, OR STIPENDIARY MAGISTRATE

I, the undersigned _______________________________________________
being (a) _________________________________________________
__________________________________________________________________
upon the petition of _____________________________________________
of (b) ____________________________________________________
in the Matter of _________________________________________________
a person of unsound mind, accompanied by the Medical Certificates
of _______________________________________________________________
and ______________________________________________________________
hereto annexed, and upon the undertaking of the said (d)
__________________________________________________________________
to visit the said ________________________________________________
personally or by some one specially appointed by the said (d)
__________________________________________________________________
once at least in every six months while under care and treatment
under this Order, hereby authorise you to receive the
said _____________________________________________________________
as a patient into your Licensed House (e).

And I declare that I have [or have not] personally
seen the said ____________________________________________________
before making this Order.

Dated this __________________ day of ________________ 19___

Signed (a) _________________________

A Justice for _________________________________
appointed under the above-mentioned Act [or the
Judge of the County Court of_____________________
or a Stipendiary Magistrate].

Urgency Orders.—Where it is urgent that an alleged lunatic (not a pauper) must be put under restraint as soon as possible, he may be received upon an urgency order, without petitioning a Judicial Authority, accompanied by a statement of particulars and one medical certificate. The order should be made by the husband, wife, or a relative of the alleged lunatic; if this be not possible, the reasons must be stated. It may be signed before or after the medical certificate, and before or after a petition order has been made. If before, it must be noted in the petition; if after, a copy must accompany the petition. No person may sign an urgency order if under twenty-one years of age, and must have seen the alleged lunatic within two days before the date of the order.

The urgency order remains in force seven days from its date, during which period the procedure for a “Judicial Order on Petition” is carried out. If the petition has been presented and the order is for some reason or other deferred, then the urgency order remains in force. The medical examination for certification must have been made not more than two days before reception, and reasons must be given why “it is expedient” that the alleged lunatic should be put under control “forthwith.”

53 Vict. c. 5.—Sched. 2.

FORM OF URGENCY ORDER FOR THE RECEPTION OF
A PRIVATE PATIENT, WITH MEDICAL CERTIFICATE
AND STATEMENT ACCOMPANYING URGENCY ORDER

Forms 4, 2, 8 and 9.

(a) House, or hospital, or asylum, or as a single patient.

(b) Name of Patient.

(d) Some day within two days before the date of the order.

(e) Husband, wife, father, father-in-law, mother, mother-in-law, son, son-in-law, daughter, daughter-in-law, brother, brother-in-law, sister, sister-in-law, partner, or assistant.

(If not the husband or wife, or a relative of the patient, the person signing to state as briefly as possible—1. Why the order is not signed by the husband or wife, or a relative of the patient. 2. His or her connection with the patient, and the circumstances under which he or she signs.)

(f) Superintendent of ____ the ____ asylum, ____ hospital or resident licensee of the ____ house (describing the asylum, hospital, or house by situation and name.)

Lunacy, Nos. 4 & 2.

(33 Vict. c. 5, s. 11.)

I, the undersigned, being a Person Twenty-one years of age,
hereby authorise you to receive as a Patient into your (a)
House (b) _______________________________________________
_______________________________________________________
as a (c) __________________________________whom I last saw at
________________________________________________________
on the (d) __________________ day of_______________ 19______

I am not related to or connected with the Person signing
the Certificate which accompanies this Order in any of the
ways mentioned in the Margin. (e) Subjoined (or annexed)
hereto is a Statement of Particulars relating to the said ____________

(Signed) ___________________________________

Name and Christian Name _______________________
at length_______________________

Rank, Profession, or Occupation ___________________
(if any)_______________________

Full Postal Address _____________________________

How related to or connected _____________________
with the patient___________________________

Dated this _______________ day of __________ 19____

Form 2.

STATEMENT OF PARTICULARS REFERRED
TO IN THE ANNEXED ORDER

If any particulars are not known the fact is to be so stated.

[Where the patient is in the petition or order described
as an idiot, omit the particulars marked ►]

The following is a Statement of Particulars		__________________
relating to the said		__________________

Name of patient, with Christian name at		__________________
length		__________________

Sex and Age		__________________
Married, single, or widowed		__________________


► Rank, profession, or previous occupation		__________________
(if any)		__________________

► Religious persuasion		__________________

Residence at or immediately previous to		__________________
the date hereof		__________________

► Whether first attack		__________________
Age on first attack		__________________

When and where previously under care		__________________
and treatment as a lunatic, idiot, or		__________________
person of unsound mind		__________________

► Duration of existing attack		__________________
Supposed cause		__________________
Whether subject to epilepsy		__________________
Whether suicidal		__________________
Whether dangerous to others, and in		__________________
what way		__________________

Whether any near relative has been		__________________
afflicted with insanity		__________________

Names, Christian names, and full postal		__________________
addresses, of one or more relatives		__________________
of the patient		__________________

Name of the person to whom notice of		__________________
death to be sent, and full postal		__________________
address, if not already given		__________________

Name and full Postal Address of the		__________________
usual Medical Attendant of the Patient		__________________

Signed (a)	____________________

When the Petitioner or person signing an Urgency Order is NOT
the person who signs the Statement, add the following particulars
concerning the person who signs the Statement.

Name, with Christian
Name at length	____________________________________
Rank, Profession or
Occupation (if any)	____________________________________
How related to, or
otherwise connected
with the Patient	____________________________________

(a) Insert residence of patient.

(b) County, city, or borough, as the case may be.

(d) Insert the place of examination, giving the name of the street, with number or name of house, or should there be no number, the Christian and surname of occupier.

(e) County, city, or borough, as the case may be.

(f) A lunatic, an idiot, or a person of unsound mind.

(g) If the same or other facts were observed previous to the time of the examination, the certifier is at liberty to subjoin them in a separate paragraph.

(h) The names and Christian names (if known) of informants to be given, with their addresses and descriptions.

Lunacy, Nos. 8 & 9.

(53 Vict. c. 5, ss. 11, 28, 29, 32 and 33.)

53 Vict. c. 5.—Sched. 2, Form 8.

CERTIFICATE OF MEDICAL PRACTITIONER

In the Matter of ___________________________________
of (a) _____________________________________________
in the (b)________________________ of ________________
(c) ________________________________________________
an alleged lunatic.

I, the undersigned __________________________________
do hereby certify as follows:—

1. I am a person registered under the Medical Act, 1858,
and I am in the actual practice of the medical profession.

2. On the _____________ day of _____________ 19 ____
at (d) ____________________________________________
in the (e) ________________ of ______________________
I personally examined the said ________________________
and came to the conclusion that ______ he is (f)___________
and a proper person to be taken charge of and detained under
care and treatment.

3. I formed this conclusion on the following grounds, viz.:—

(a) Facts indicating Insanity observed by myself
at the time of examination (g), viz.:—

______________________________________________
______________________________________________
______________________________________________
______________________________________________

(b) Facts communicated by others (h), viz:—
______________________________________________
______________________________________________
______________________________________________
______________________________________________

(i) If an urgency certificate is required, it must be added here.—Form No. 9.

53 Vict. c. 5.—Form 9.

(i) STATEMENT ACCOMPANYING
URGENCY ORDER

I certify that it is expedient for the welfare of the said
_______________________ (or for the public safety, as
the case may be) that the said ________________________________
should be forthwith placed under care and treatment.

My reasons for this conclusion are as follows: __________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________

(k) Strike out this clause in case of a private patient whose removal is not proposed.

4. The said ___________________________________
appeared to me to be [‡ _____________] in a fit condition
of bodily health to be removed to an asylum, hospital,
or licensed house(k).

(‡) Or not to be.

5. I give this certificate having first read the section of the Act
of Parliament printed below.

Dated this ________________ day of ________________
One thousand nine hundred and ______________

(l) Insert full postal address.

(Signed) _____________________________
of (l) _____________________________

Extract from section 317 of the Lunacy Act, 1890.

Any person who makes a wilful misstatement of any
material fact in any medical or other certificate,
or in any statement or report of bodily or mental
condition under this Act, shall be guilty of a misdemeanour.

Orders after Inquisition.—This constitutes a legal investigation as to whether or not a person is capable of managing his or her own affairs, and whether restraint is necessary. It is conducted before a judge, with a jury if the alleged lunatic demand one, unless the judge is satisfied by personal examination that the lunatic is not mentally competent to understand the demand for a jury. In such a case the medical man is only concerned as a witness.

According to circumstances the alleged lunatic may be kept under restraint, or remain at liberty with the control of his or her affairs under a “Committee of Estate”; or, if declared sane, set free and with control of his estate.

Summary Reception Orders.—When a lunatic is not under proper control, and if without relations or friends, and there be no one who will sign a petition for detention, or when a lunatic is uncared for, cruelly treated, and is found so by a medical practitioner, his duty is to inform a constable, relieving officer, or overseer of the parish of the fact. The official will then make a statement on oath to a Judicial Authority, who will direct two medical practitioners to make the necessary examinations, and if satisfied he will issue an order for the removal of the individual to an asylum. The procedure followed will then be the same as for a “petition for reception.” Under a summary reception order the Judicial Authority may place the person under the care of a relation or friend, or the visitors of the asylum in which the person is intended to be, or is placed.

Lunatics Wandering at Large.—Every constable, relieving officer, or overseer of a parish who knows of a person, whether pauper or not, who is deemed to be a lunatic and wandering at large, shall apprehend and take such person before a Justice, or if the Justice receive information on oath, he may have the person apprehended and brought before him. The Justice has the person medically examined, and if certified a lunatic to the satisfaction of the Justice, he may issue an order for detention; if the medical man certify that the person is not fit for removal, the removal is postponed until the person is certified fit for it.

The above proceedings are not necessary if it be considered a matter of public safety and for the good of the alleged lunatic that immediate detention be carried out. The constable, relieving officer, or overseer of the parish may remove such person to the workhouse of the union in which the person is, and detain him for not more than three days. Before the expiration of that time the necessary proceedings under the Lunacy Act must be taken.

Reception Order by two Commissioners.—Any two or more Commissioners in Lunacy may visit a pauper lunatic or an alleged lunatic not detained in a workhouse or lunatic asylum, and if satisfied after certification by a medical man that the person is a lunatic, order removal to an asylum.

Pauper Lunatics.—A medical officer of a Poor Law Union who has knowledge that a pauper within his district is alleged to be a lunatic, shall notify the relieving officer or overseer of the parish where the pauper resides of the fact, who within three days shall notify a Justice, who will interview the alleged lunatic and call in a medical practitioner to examine and certify. If the Justice be satisfied that the person be a lunatic, he makes an order for removal to an asylum. One medical certificate only is necessary.

Escape of Lunatics.—An escaped lunatic may be retaken at any time within fourteen days without a fresh order.

Discharge of Lunatics.—The reception order remains in force for periods of one, two, and three years, and then for periods of five years. At the end of any of these periods the Lunacy Commissioners may continue the detention of the lunatic, if satisfied by certification from the medical man of the institution, or the usual medical attendant of the lunatic, that the patient remains of unsound mind and further detention is necessary.

The petitioner of the reception order may request the discharge of a patient. The discharge may be refused if the medical man in charge certifies the lunatic dangerous and unfit to be at large, unless two of the visitors to the asylum or the Commissioners visiting the asylum or house give their consent in writing.

Two Commissioners—one medical, the other legal—may order the discharge of any patient.

When a patient recovers, the medical attendant of the institution notifies this to the petitioner or person responsible for the payment on account of the patient. Should the patient not be removed within seven days of such notice, the patient may be discharged “forthwith.”

PROCEDURE IN SCOTLAND

Idiots and imbeciles under eighteen years of age may be received into training schools without the legal procedure which obtains in England and Wales. They are sent to these institutions as lunatics, however, under the usual legalities, in order that the Government grant may be obtained. When over eighteen years of age, if sent to institutions other than training schools, they are classed as lunatics, and the necessary legal procedure is followed.

Insane persons whose malady is not confirmed may be cared for privately for a period not exceeding six months. The certificate of one medical practitioner only is required.

Insane persons, pauper or not, can be placed in an asylum by order of the Sheriff, by petition and two medical certificates. The inspector of the poor acts as petitioner for paupers.

In cases of urgency a certificate of emergency from one medical practitioner is required, along with a request from the petitioner, to the superintendent of the asylum.

A person who is prodigal or facile can be restrained from alienating his property by guardians appointed by the Court.

When a lunatic is found to be incapable of administering his or her estate, the Court appoints a Committee of Estate.

PROCEDURE IN IRELAND

The procedure differs in pauper and private cases.

Pauper patients, not dangerous.—In order to detain such a pauper there must be a declaration of insanity and destitution, with the names and addresses and descriptions of two relatives of the person, given before a magistrate. A magistrate and a clergyman or poor-law guardian must certify that they have personally inquired into the case. One medical certificate is necessary. The applicant must remove the patient when called upon.

Paying patients who are not dangerous, for admission to a district asylum, are under more stringent regulations. A declaration that they are unable to pay the expenses necessary for support in a licensed house must be made before a magistrate; further, that there is no friend who can undertake this; and a statement of the length of time the patient has resided in the country. A magistrate and clergyman must certify that they have investigated the case. One medical certificate must be signed by two practitioners. A guarantee for the payment must be given, and also to remove the patient when called upon. The sanction of an inspector of lunatics must be given.

For admission into licensed houses, charitable institutions, and single care, an order by a relative or connection of the lunatic is required with two medical certificates, unless urgent, when one is sufficient, but a second must follow within fourteen days.

LIABILITIES OF PERSONS SIGNING
LUNACY CERTIFICATES

A medical practitioner is bound to certify as to the sanity of a person. If, however, he undertakes to fill up the certificates necessary for the detention of an alleged lunatic, he becomes responsible to the authorities for the correctness of the certificates, and if he make a wilful misstatement of facts he is guilty of a misdemeanour. The medical practitioner may have an action brought against him by the lunatic when recovered or discharged. The most vindictive feelings may be entertained against the medical man. In such a case, if the medical man proves his “good faith” and the exercise of “reasonable care” in his examination and certification, he receives the protection of the Court.

LIABILITIES OF PERSONS RECEIVING
INSANE PATIENTS

In the case of Nottidge v. Ripley and Nottidge, the Lord Chief Baron having been understood to intimate an opinion that no person ought to be so confined unless he is dangerous to himself or others, the Commissioners pointed out that the scope of the Lunacy Acts is not thus limited. They said:

“The object of these Acts is not, as your Lordship is aware, so much to confine lunatics, as to restore to a healthy state of mind such of them as are curable, and to afford comfort and protection to the rest. Moreover, the difficulty of ascertaining whether one who is insane be dangerous or not is exceedingly great, and in some cases can only be determined after minute observation for a considerable time.

“It is of vital importance that no mistake or misconception should exist, and that every medical man who may be applied to for advice on the subject of lunacy, and every relative and friend of any lunatic, as well as every magistrate and parish officer (each of whom may be called upon to act in cases of this sort), should know and be well assured that, according to law, any person of unsound mind, whether he be pronounced dangerous or not, may legally and properly be placed in a county asylum, lunatic hospital, or licensed house, on the authority of the preliminary order and certificates prescribed by the Acts.

“Upon the whole, it appears that the power to restrain and confine a lunatic is limited at common law to cases in which it would be dangerous, either as regards others or himself, for the lunatic to be at large; but that the power to place and detain a lunatic in a registered hospital or licensed or other house, under an order and medical certificates duly made and obtained in accordance with the Lunacy Acts, is not so limited.”

The terms of the Lunacy Act, 1890, are as follows:

“Subject to the exceptions in this Act mentioned a person shall not be received or detained as a lunatic, as a single patient, unless under a reception order by a judicial authority.” “Every person who, except under the provisions of the Act, receives or detains a lunatic or an alleged lunatic in an institution for lunatics, or for payment takes charge of, receives to board or lodge, or detains a lunatic or alleged lunatic in an unlicensed house, shall be guilty of a misdemeanour, and in the latter case shall also be liable to a penalty not exceeding fifty pounds.” “Except under the provisions of this Act, it shall not be lawful for any person to receive or detain two or more lunatics in any house, unless the house is an institution for lunatics or a workhouse.” “Any person who receives or detains two or more lunatics in any house except as aforesaid shall be guilty of a misdemeanour.”

It is therefore unlawful to receive a lunatic or alleged lunatic except by reception order. Only one can be received into a private house, and a reception order is required. No medical man should receive a lunatic into residence without the necessary reception order. All the statutory regulations are demanded for a single case, and the private house is subject to visitation and inspection.

It is also important to remember that if any one receive a person not insane at the time, but who subsequently becomes insane, he renders himself liable to prosecution, unless he procure the necessary medical certificates and order (R. v. Wilkins).

Is a Lunatic a competent Witness?—Mr. Fitzjames Stephen maintains (Criminal Law) that madmen are competent witnesses in relation to testimony as in relation to crime. If they understand the nature of an oath, and the character of the proceedings in which they are engaged, they are competent witnesses whatever be the nature or degree of their mental disorder. An idiot shall not be allowed to give evidence (Co. Litt. 6 b; Gilb. Ev. 144); a lunatic during a lucid interval may do so (Id. Com. Dig. Testm. {A}). When a lunatic is tendered as a witness, it is for the judge to examine and ascertain whether he is of competent understanding to give evidence, and is aware of the nature and obligation of an oath; if satisfied that he is, the judge should allow him to be sworn and examined (R. v. Hill, 2 Den. 255; 20 L.J. [M.C.] 222).

The Civil Rights of Lunatics.—If an individual be suffering from such mental disease as to render him incompetent to manage his own affairs, the law steps in to protect him and his property from injury. But the power so used does not necessarily imply that he is deprived of his personal freedom, but merely such restraint as is necessary for his protection.

Many lunatics, under the protection of the Court, live in their own houses with large establishments. A person so protected by the law is said to be subject to an “interdiction.” In these cases a commission is usually granted by the Court of Chancery, and a writ known under the name of “de lunatico inquirendo” issued, after certain legal matters of detail are settled, and affidavits from medical men certifying to the insanity of the party have been filed.

The tests of insanity in these cases differ from those required in criminal cases, where the knowledge of right from wrong is imperatively demanded. The mental defect must not be the result of ignorance or want of education, and at one time commissions were only issued when it was shown that lunacy and idiocy alone existed, imbecility or mere weakness of mind not being deemed sufficient to deprive a man of his civil rights, or to place him under the protection of the Court.

To so great an absurdity did this lead, that the man suffering from a delusion sufficient to be comprehended under the legal term “lunacy” was protected, whereas the feeble-minded were left without interference, though needing it more. The cost of these commissions sometimes reached almost fabulous sums. The expense has been somewhat lessened by recent enactments, and the process simplified—the Lord Chancellor having it in his power to direct an inquiry before two Commissioners, thus dispensing with a jury. (See the 16 and 17 Vict. c. 70, and 25 and 26 Vict. c. 86.)

In Scotland, however, the law is far more simple. The cognition proceeds on a brieve or writ addressed to the Lord President of the Court of Session, and directs him to inquire “whether the person sought to be cognosced is insane, who is his nearest agnate, and whether such agnate is of lawful age.” “And such person shall be deemed insane if he be furious or fatuous, or labours under such unsoundness of mind as to render him incapable of managing his affairs.” “The trial is before a judge of the Supreme Court and a special jury. If the insanity be proved, the nearest agnate—relation by the father‘s side—is by law entitled to the guardianship.” No one not a near relative can institute these proceedings.

In Scotland also, the trial by jury may be avoided by applying by petition to the Court of Session for the appointment of a judicial factor or curator bonis. Of this appointment the alleged lunatic is informed, which, if he please, he may oppose; medical evidence is received, and on this the Court rests its decision—the usual course being to remit the case to some competent person to make inquiry, take evidence, and report. The Commissioner is usually the Sheriff.

Examination of the Insane.—A few words of caution need here be said. Medical men will consult their own dignity and that of their profession by remembering that in cases of alleged insanity, as in fact in all other cases when their opinion is sought, they are not justified in taking sides. Their evidence will be the more valuable in proportion to the care they take in examining into the facts of the case, and the good sense and judgment shown in their examination of the patient. To distinguish between the mistakes, the result of ignorance and want of education, and those the result of a feeble mind, is of primary importance. It is no sign of insanity in an uneducated farmer that he knows not the pons asinorum. All cases should be tested by considering the surroundings and possible degree of culture of a person placed under like conditions as the party under examination. Has he shown himself capable of an average amount of culture? or is his mental condition inferior to what one might legitimately expect under the influences to which he has been subjected? The medical examiner should also direct his attention to this important point, setting aside all legal and medical theories of insanity, viz.—“Is the case of such mental disorder as to create an incapacity for managing affairs.”