Alcoholic Insanity.—This may occur in three forms:
- Acute Alcoholic Delirium (mania a potu), due to excessive amount of alcohol consumed.
- Delirium Tremens, due to long-continued over-drinking. The patient suffers from horrible dreams, illusions, and suspicions, which may lead him to attack people or commit suicide.
- Chronic Alcoholic Insanity. Loss of memory is the chief symptom, with paralysis of motion, hallucinations and delusions of persecution.
Responsibility for Criminal Acts.—To establish a defence on the ground of insanity, it must be proved that the prisoner at the time when the crime was committed did not know the nature and quality of the act he was committing, and did not know that it was wrong. At the present time, however, the power of controlling his actions is usually made the test.
The plea of insanity is brought forward, as a rule, only in capital charges, so that the prisoner, if found guilty, will escape hanging. If proved 'guilty, but insane,' the person is sentenced to be kept in a criminal lunatic asylum 'during His Majesty's pleasure.'
XLIV.—EXAMINATION OF PERSONS OF UNSOUND MIND
The following hints with regard to the examination of patients supposed to be insane will be useful: The general appearance and shape of head, complexion, and expression of countenance, gait, movements, and speech, should be noted; the state of the general health, appetite, bowels, tongue, skin, and pulse, should be inquired into; and in women the state of the menstrual function should be ascertained. The family history must be traced out, and the personal history taken with care, especially as to whether the unsoundness came on late in life or followed any physical cause. Ascertain whether it is a first attack, whether the patient has suffered from epilepsy, has squandered his money, grown restless, has absurd delusions, etc. In order to ascertain the capacity of the mind, questions should be asked with regard to age, birthplace, profession, number of family, and common events, such as the day of week, month, and year. The power of performing simple arithmetical operations may be tested. It may be necessary to pay more than one visit. The examiner should be careful to ask questions adapted to the station of life of the supposed lunatic; a man is not necessarily mad because he cannot perform simple arithmetical operations, or does not know about things with which his questioner is well acquainted. The opinion of a supposed lunatic that his examiner's feet were large was not considered by the Commissioners among the facts indicating insanity, yet statements quite as absurd are made by medical men as 'facts of insanity' observed by themselves. 'Reads his Bible and is anxious about the salvation of his soul' is another example of a bad certificate. Some well-marked delusion should be recorded.
For a lunacy certificate (Reception Order on Petition or Judicial Reception Order), except in the case of a pauper patient, there are required the signatures of two independent medical men and of a relation or friend. The medical men must not be in partnership or in any way interested in the patient; they must make separate visits at different times, and write on the proper forms the facts observed by themselves and those observed by others, giving the name of the informer. A certificate is valid only for seven days. In very urgent non-pauper cases the signature of one medical man is sufficient, but such certificate (Emergency Certificate or Urgency Order) is only valid for two days, and, as the patient can only be detained in the asylum under this order for seven days in England or three in Scotland, it must be supplemented by another signed as above directed. The medical certificate must contain a statement that it is expedient for the alleged lunatic to be placed forthwith under care, with reasons for making such statement. The certifying medical practitioner must have personally examined the patient not more than two clear days before his reception. In London and other large towns, where an expert opinion is readily obtainable, it is not expedient to resort to such urgency orders. Medical men should be careful how they sign certificates of insanity. No medical man is bound to certify, but if he does so he must be prepared to take the responsibility of his acts. There must be no reasonable ground for alleging want of 'good faith' or 'reasonable care.' The practitioner must exercise that amount of care and skill which he may reasonably be expected to possess.