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must be in no way related to the petitioner; he must not be a partner or assistant to the other medical certifier; he must have no financial interest in the place where the lunatic is placed ; he cannot act as medical attendant to the lunatic while he is under restraint.
Wilful mis-statements of fact or false statements in a lunacy certificate may render the certifier guilty of a misdemeanour and may entail a penalty of £300 or imprisonment for any period up to twelve months. In addition, a civil action for damages may be brought against him for wrongous certification.
Discharge of Lunatics.—Oneought to be very careful in granting a certificate recommending the discharge of a lunatic. The medical man giving one ought to be guided greatly by the advice of the superintendent. One interview is not always a sufficient test, as it might be on the occasion of a lucid interval, and these intervals are often prolonged in point of time. If, however, you are certain in your own mind that the patient has regained his sanity and think that he ought to be discharged from the asylum, you grant a certificate somewhat as follows:
—“I hereby certify on soul and conscience that I have this day seen and examined J. D., and that he is now of sound mind and fit to manage his own affairs or give directions for their management."
It is chiefly in regard to suicidal and homicidal lunatics that you must exercise extreme care. You ought only to grant such a certificate after lengthened inquiry, as the mania may remain latent for long, only waiting an opportunity to show itself.
Management of the Property of a Lunatic. It is often necessary to prevent a lunatic from having the management of his property or business, though it may not be necessary to confine him in an asylum. In England an application in such cases is made to the Master in Lunacy, who will appoint a receiver and give directions as to the property. In Scotland, on application the court appoints a lawyer or accountant to do this. He is called the judicial factor or curator bonis. The two medical certificates should state " that the person is insane, and incapable of managing his own affairs or of giving directions for their management."
Testamentary Capacity.-Dispositions or wills are very frequently disputed on the ground that the testator was of unsound mind, or owing to advanced age or through being unduly influenced, he was not able to make a proper distribution of his estate.
If, therefore, the medical attendant knows that his patient is making a trust disposition, it is his duty to investigate carefully into his mental and intellectual ability to do so, in view of the possibility of the will being contested.
If the practitioner be asked to be a witness to this disposition, then still more ought he to inquire into the mental state of the disponer. He ought to ask him if he knows perfectly what he is doing and how he is distributing his estate. Get him to tell you some of the provisions he has made and see if they agree with the deed.
Make sure to your own satisfaction that he is of a disposing mind”; that he knows the nature and extent of his property, the persons who have claims on him and the relative degree of these claims. Should the settlement be disputed you are then able to swear to the fact that the testator knew exactly what he was doing. Your signature as a medical man to a will should be equal to a certificate of mental competency given to the testator. You must remember that if you sign your name as witness to a disposition, neither you nor your wife can benefit under that will.
On the other hand, if you are convinced that he is not in a fit mental state to make a proper will, then you must refrain from acting as a witness. But further, you ought to write a letter to the lawyer stating your opinion, and this action would assist greatly if the dispute were taken to court.
Undue Influence. The medical attendant will be able to estimate for himself during his visits to an infirm or aged patient whether undue influence is being brought to bear on him by some relative or attendant. It must be rare when the practitioner does not note evidences of excessive and interested attention. He will be able to gauge the degree of mental enfeeblement of his patient and note if he is easily persuaded. He can judge what value his patient puts on the services given by the attendant and whether he has alluded to rewarding him or her at his death. In disputed wills, the medical attendant will be able to give valuable evidence, both as regards the mental condition of the deceased and as to the assiduity of attention bestowed by the beneficiary.
Legacy to Medical Attendant.-It not infrequently happens that a grateful patient leaves a legacy to his
medical attendant, or to some member of his family. If the sum so left is small, it is usually paid by the legatee without cavil. But if the sum bequeathed be large, the legatees very often dispute the legacy in a court of law, affirming that the deceased was not of a disposing mind, or that the medical attendant had exercised undue influence on his patient. In only too many cases the courts have decided against such legacies.
If a patient intimates his desire to leave you a legacy, then you should make this known to your patient's lawyer, or to his immediate relations, so that they may be fully acquainted with the intention of their relative towards you, and may have the opportunity of talking the matter over with him or her.
Should your patient, after intimating his desire to leave you this legacy, ask you to keep the matter secret, then you must tell him that his intention would not be fulfilled unless it was made known to his immediate relatives. If he is of sound mind and really wishes you to have this legacy, he will appreciate the force of your statement, and will see to it that this provision of his disposition will be properly carried out after his death.
VACCINATION AND OTHER CERTIFICATES
Vaccination.—A certificate of successful vaccination must only be given if you have inspected the arm a week after the operation and found that the inoculation has been successful. Lately a medical man was remitted to the assize court because after vaccinating a child he had immediately given a certificate of successful vaccination.
Postponement of Vaccination.-You have no power to delay vaccination on account of the health of a child for a longer period than two months at one time. You may repeat this certificate if, in your opinion, the child's health is still precarious.
Insusceptibility to the Vaccine Disease. This certificate ought never to be required. You may only fill it up if you have not succeeded in vaccinating the child after three attempts. This means that either the lymph you used was not reliable, or that you were not performing the inoculation properly. Hardly any children are insusceptible to vaccination.
As a private practitioner you are legally allowed to practice arm-to-arm inoculation if you desire
to do so. In view, however, of legal troubles which might arise, you ought to employ glycernised calf lymph in every case. If you use human lymph, it may be stated that you employed lymph from a