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the death. In Scotland it is more usual for the death certificate to be transmitted directly to the registrar by the medical attendant. This is the better method, and should always be followed. When one gives it to a relative of the deceased, one cannot be sure that he will hand it to the registrar. If you do not send it yourself, give very definite instructions for the certificate to be taken to the registrar.

CHAPTER XII

LUNACY IN RELATION TO LAW

Lunacy Certificates.-The filling up of certificates of lunacy entails a heavy responsibility on the medical practitioners who sign them, and rightly so, for it means that the liberty of the individual is to be taken from him. When certified he will no longer be a free agent, but will be compelled to live in a certain asylum or, at least, the management of his affairs will be taken out of his power.

Before, therefore, signing a lunacy certificate you must make yourself certain as to the individual's insanity or incompetence to manage his affairs. In some cases this is by no means an easy matter to decide. The statements of friends and relatives of the alleged lunatic are often biased and inimical. Should he have been addicted to over-indulgence in alcohol, this will have made him a worry and distress to his family and, consequently, they are only too anxious in many cases to exaggerate symptoms in order to have him placed under restraint. You ought, therefore, not to be unduly influenced by their statements, though listening to them with attention because you will have to embody the most telling of these in your certificate, under the heading of " (2) Other facts (if any) indicating insanity communicated to me by others." Such statements of his wife that "he comes home very late at night," "that he wanders about the house through the

night," "that he uses foul language," etc., do not indicate insanity. Were you to write down, however, that "his wife tells me that formerly he was a deeply religious man, but now he swears and has become filthy in his habits, that he neglects his business, to which he was formerly devoted," etc., such would convey much more definite information.

If you are not satisfied in your own mind that the individual is insane, then have no hesitation in refusing to fill up the certificate.

Wrongous certification is more often the result of preconceived ideas, hurry and carelessness than of actual design, and yet these may end in your having to pay heavy damages.

On the other hand lose no time, but fill up an emergency certificate if the individual is a suicidal or homicidal maniac, and so get him placed under care at once. If you are remiss in doing so it may be a life-long regret to you, as dreadful crimes are only too often committed by such lunatics.

Many acute cases of mental disease recover, however, in a short time if the person is placed in a nursing home and carefully looked after and treated. In this way you avoid placing the stigma of certification upon an individual. Indeed, the Mental Treatment Act of 1915 allows you to place under detention and treatment for a period not longer than six months cases of mental disease which appear of a temporary nature, and this without certification.

In Scotland a person so suffering may be placed under private care on the certificate of one medical man. This is in the following terms :—

"I, A. B., a medical person duly qualified in

terms of the Act 20 & 21 Vict. cap. 71, certify, on soul and conscience, that C. D. (name and design the patient) is afflicted (state the nature of the disease), but that the malady is not confirmed, and that I consider it expedient, with a view to his recovery, that he should be placed (specify the home in which the patient is to be kept) for a temporary residence of (specify a time not exceeding six months).”

Rules for Filling Up the Lunacy Certificate.These certificates are to be obtained from any law stationer, magistrate's or justice's clerk, or from the asylum in which it is proposed to place the patient. Take great care in filling up the certificate, which is, after all, a legal document, and as such must be exact. Very often the asylum doctor has to return it to the medical man who signed it, for correction, often in some mere detail. Read the directions carefully before writing anything, especially the extract of section 317 of the Lunacy Act of 1890, and which you will find printed at the end of the English lunacy certificate. In answer to the question "(1) Facts indicating insanity ascertained by myself," give ample and convincing proofs of the individual's insanity. Remember that the statement which you make must bring conviction to the mind of the judicial authority (who is a layman) that the individual is certainly insane. If the patient has any delusions, state what they are, as, for example, "states that he is God; addresses his heavenly hosts and orders them to do his bidding; he talks constantly, and hardly takes time to answer questions; he is restless and untidy, his clothes are unbuttoned."

Having completed one certificate, another practitioner, who is in no way related to you either in family or practice, must examine the patient at another time (preferably several hours' interval), but not along with you.

The petition having been completed, it must be presented to the judicial authority. In England this may be the judge of a county court, a stipendiary magistrate, a justice of the peace, or the chairman of the Board of Guardians appointed under the Lunacy Act. In Scotland it is the sheriff of the county. Any one of these having completed the order, it must be acted upon within seven days or else the whole petition fails.

In cases of emergency the Urgency Order allows of the patient being put under restraint on one medical certificate only. He cannot, however, be detained for a longer period than seven days in England and three days in Scotland. These periods allow, however, for the usual methods of certification to be carried through. This order must be acted upon within two days.

Idiots and Imbeciles may be placed in institutions or under guardianship. Two medical certificates are necessary, one of which must be from a practitioner approved by the local authority under the Mental Deficiency Act, 1913, or by the Board of Control.

Defectives, who are not idiots or imbeciles, may be placed in institutions as above if two medical certificates along with one from the judicial authority are presented.

The medical man who fills up a lunacy certificate

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