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Articles from Aids To Forensic Medicine And Toxicology

Feigned Diseases

Detection Of Blood-stains Etc

Dementia: Acute Chronic Senile And Paralytic

Cause Of Death In The Foetus

Nitric Acid

Lead And Its Preparations

Copper And Its Preparations


Alcohol Ether And Chloroform

Antipyrine Antifebrin Phenacetin And Aniline

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.

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