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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
br /> 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.