Chapter 16 of 31 · 15368 words · ~77 min read

CHAPTER XVI

MENTAL UNSOUNDNESS

In the whole range of medical jurisprudence there is no subject more interesting, more difficult, or more important than the diagnosis of insanity, and its relation to the criminal responsibility of individuals. It is impossible, in the short space at our disposal, to do more than to offer a few remarks which may assist the student in the elucidation of some of the most important cases which may engage his attention.

=Legal Definitions.=--Three forms of mental disorder are recognised in law:

1. _A nativitate, vel dementia naturalis_--idiocy or imbecility.

2. _Dementia accidentalis, vel adventitia_--acquired general insanity, either temporary or permanent, lunacy.

3. _Dementia affectata_, acquired madness from intoxication, &c. (See “Delirium Tremens,” p. 205.)

Under the term lunacy are included the mania, monomania, and dementia of medical writers. Another term frequently used in legal proceedings, the meaning of which it is not easy to give, is “_non compos mentis_,” _unsoundness of mind_. According to the late Forbes Winslow, “unsoundness of mind is not lunacy” in the legal acceptance of the phrase. This term was first used in a Statute passed in the reign of Henry VIII., relating to the punishment of treasonable offences, and is defined by the early law text-books to be strictly one who _gaudet lucidis intervallis_--a definition not psychologically exact. The phrase “unsoundness of mind” was first used by the late Lord Eldon to designate a state of mind not exactly idiotic, and not lunatic with delusions, but a condition of intellect occupying a place between the two extremes, and unfitting the person for the government of himself and the management of his affairs.

The above definition has been acted upon by other judges--Lyndhurst, Brougham, &c. As a rule, a medical witness will consult his own interest in not attempting to define insanity, bearing in mind the philosophic caution of Polonius, who, when addressing Hamlet‘s mother, says--

“Your noble son is mad: Mad call I it; for, to define true madness, What is‘t but to be nothing else but mad?” To the legal mind, the chief character of insanity is the presence of _delusion_; but this view is far too restricted. It was first advanced by Erskine in the trial of Hadfield. Before that trial the doctrine was that every man was responsible for his acts, unless he was totally deprived of his understanding and memory, and did not know what he was doing, “no more than an infant, than a brute, or a wild beast” (R. _v._ Arnold). In the case of Bellingham, the knowledge of “right” and “wrong” in the abstract was the test of mental unsoundness; and, as in the opinion of the judge and jury he was held to be capable of solving this metaphysical problem, Bellingham was duly hanged.

Since the trial and acquittal of MacNaughton on the ground of insanity, the doctrine of the knowledge of abstract right and wrong has been changed to a knowledge of right and wrong in relation to the particular act of which the person is accused, and also at the time of committing it.

It has also been held that, on the assumption that a person labours under partial delusion only, and is not in other respects insane, he must be considered in the same situation as to responsibility as if the facts, with respect to which the delusion exists, were real. For example, if, under the influence of delusion, he supposes another man to be in the act of attempting to take his life, and he kills that man, as he supposes, in self-defence, he would be exempt from punishment. If his delusion were that the deceased had inflicted a serious injury on his character and fortune, and he killed him in revenge for such supposed injury, he would be liable to punishment. “Here,” says Maudsley, “is an unhesitating assumption that a man, having an insane delusion, has the power to think and act in regard to it _reasonably_, ... that he is, in fact, bound to be reasonable in his unreason, sane in his insanity.” Yet this was the doctrine laid down by the judges in answer to certain questions propounded by the House of Lords after the acquittal of MacNaughton (see Maudsley‘s _Responsibility in Mental Disease_, pp. 88 _et seq._).

As laid down by English lawyers, madness absolves from all guilt in criminal cases. Where the deprivation of the understanding and memory is total, fixed, and permanent, it excuses all acts; so, likewise, a man labouring under adventitious insanity is, during the frenzy, entitled to the same indulgence, in the same degree, as one whose disorder is fixed and permanent (Beverley‘s Case, Co. 125, Co. Litt. 247, 1 Hale 31). “But the difficulty in these cases is to distinguish between a total aberration of intellect and a partial or temporary delusion merely, notwithstanding which the patient may be capable of discerning right from wrong; in which case he will be guilty in the eye of the law, and amenable to punishment.”[17]

[17] Archbold‘s _Criminal Cases_.

Lord Hale, who first pointed out the distinction to be drawn between total and partial insanity, offered the following as the best test he could suggest: “Such a person, as labouring under melancholy distempers, hath yet as great understanding as ordinarily a child of fourteen years hath, is such a person as can be guilty of felony.” (On this subject, see R. _v_. Ld. Ferrers, 19 St. Tr. 333; R. _v_. Arnold, 16 St. Tr. 764, &c.)

To excuse a man from punishment on the ground of insanity, it appears that it must be distinctly proved that he was not capable of distinguishing right from wrong, and that he did not know, at the time of committing the crime, that the offence was against the laws of _God_ and _nature_ (R. _v_. Offord, 5 C. & P. 186).

I shall here quote from Macdonald‘s _Criminal Law of Scotland_: “Insanity or idiocy exempts from prosecution. But there must be an alienation of reason such as misleads the judgment, so that the person does not know ‘the nature of the quality of the act’ he is doing, or if he does know it, that he does not know he is doing what is wrong. If there be this alienation, as connected with the act committed, he is not liable to punishment, though his conduct may be otherwise rational. For example, if he kill another when under an insane delusion as to the conduct and character of the person--_e.g._ believing that he is about to murder him, or is an evil spirit,--then it matters not that he has a general notion of right and wrong. For, in such a case, ‘as well might he be utterly ignorant of the quality of murder.’ He does the deed, knowing murder to be wrong, but his delusion makes him believe he is acting in self-defence, or against a spirit. Nor does it alter the effect of the fact of insanity at the time, that the person afterwards recovers.... But the alienation of reason must be substantial. Oddness or eccentricity, however marked, or even weakness of mind, will not avail as a defence. Even monomania may be insufficient as a defence, where the delusion and the crime committed have no connection, or where the person, though having delusions, was yet aware that what he did was illegal.”

Mere moral insanity--where the intellectual faculties are sound, and the person knows what he is doing, and that he is doing wrong, but has no control over himself, and acts under an uncontrollable impulse--does not render him irresponsible (R. _v_. Burton, 3 F. & F. 772). Some medical writers contend that there are two forms of insanity--moral and intellectual. The law only recognises the latter, owing probably to the difficulty of distinguishing between so-called moral insanity and moral depravity. Taylor says: “Further, until medical men can produce a clear and well-defined distinction between moral depravity and moral insanity, such a doctrine, employed as it has been for the exculpation of persons charged with crime, should be rejected as inadmissible.”

The day may not be far distant when the term “moral depravity” will be unknown, and future generations, ceasing to believe in absurd superstitions, will come to look on crime as the result of disease of the brain, and learn to treat, instead of to punish, the morally diseased. (For a full discussion of this subject the reader is referred to the works of Dr. Henry Maudsley.)

The fact of the sanity or insanity of the prisoner at the time the crime was committed is left to the jury to decide, guided by the previous and contemporaneous acts of the party; and it has been laid down by Lord Moncreiff in Scotland, and Lord Westbury in England, that the mental soundness or unsoundness of any individual is to be decided by the jury on the ordinary rules of every-day life, and that on these principles they are as good judges as medical men. The whole tendency of legal practice, when dealing with the plea of insanity, is to entirely ignore the medical evidence. On the question of medical evidence in cases of insanity, Doe J., of New Hampshire, remarks: “At present, precedents require the jury to be instructed by experts in new medical theories, and by judges in old medical theories,” and that in this “the legal profession were invading the province of medicine, and attempting to install old exploded medical theories in the place of facts established in the progress of scientific knowledge. If the tests of insanity are matters of law, the practice of allowing experts to testify what they are should be discontinued; if they are matters of fact, the judge should no longer testify without being sworn as a witness, and showing himself qualified to testify as an expert.”

=Lunacy--What Constitutes?= (8 and 9 Vict. c. 100, secs. 90 and 114).--Imbecility and loss of mental power, whether arising from natural decay, or from paralysis, softening of the brain, or other natural cause, and although unaccompanied with frenzy or delusion of any kind, constitute unsoundness of mind, amounting to lunacy within the meaning of 8 and 9 Vict. c. 100 (R. _v_. Shaw, 1 C.C. 145).

The above is the last definition of lunacy up to 1875; but as the law on this subject is so constantly changing, the student will find it best to consult the _Law Reports_ from time to time. (See the account in the case of R. _v_. Treadaway, _Law Reports_. Also the _Lancet_, on the same case, vol. i. 1877.)

For some valuable remarks on the subject of the irresponsibility of madmen, the student is referred to the works of Maudsley, Pritchard, Ray, Hoffbauer, Georget, and others.

The following suggestions are offered for consideration on this subject:

1. Was the act an isolated event in the life of the culprit? Has it the appearance of spontaneity, or was it the culminating point of a life spent in so-called criminal acts?

2. _Absence of a motive for the committal of the deed._--The absence of an _apparent_ motive is no proof of an unsound mind; the moving principle may be _“the conscious impulse to the illegal gratification of a selfish desire_.”

3. _The presence or absence of a well-concerted plan of action is a diagnostic sign of little value._--Casper remarks that “only in one case can the examination of the systematic planning of the deed afford any information, and that is when these plans and preparations themselves evince the stamp of a confused intellect, and betray the hazy consciousness, the mental darkness, in which the culprit was involved.”

4. _A dominant delusion may be so concealed as to be for a time undiscoverable._--The case of the man who gave no indication of his madness till he was asked to sign the order for his release, when he signed _Christ_, is an example how carefully a delusion may be concealed even during a most careful examination. Questions directed to this point showed that he laboured under all the errors which such a delusion might suggest.

5. It may “easily be conceived that insane persons, whose unreason affects only one train of thought more or less restricted, yet labour in other respects under disorders of feeling which influence their conduct and their actions and behaviour without materially affecting their judgment: and that many of such deranged persons, who often conduct themselves tolerably well in a lunatic asylum, and while living among strangers with whom they have no relations, and against whom they have no prejudices or imaginary reason of complaint; subjected, besides, to the rules of the house and to an authority that nobody attempts to dispute; would, nevertheless, if restored to liberty and residing in the midst of their families, become insupportable, irritable at the slightest contradiction, abusive, impatient of the least remark on their conduct, and liable to be provoked by trifles to the most dangerous acts of violence. If, under such circumstances, a lunatic should commit any act of injury or serious damage to another, would it be just to punish him; because it cannot be made apparent that the action has any reference to, or connection with, the principal delusion which is known to cloud his judgment, it being apparent that his moral faculties have undergone a total morbid perversion?”

6. _Insanity with Lucid Intervals._--Haslam, Ray, and others appear to deny the possibility of lucid intervals; but M. Esquirol, on the other hand, fully recognises the existence of this form of insanity. In a legal sense, a temporary cessation of the insanity constitutes a lucid interval, but the cessation must be complete, and not merely a remission of the symptoms. The interval must be of some duration; and when continuous insanity has been proved, the onus of proving a lucid interval in civil cases rests with the party trying to support the validity of a deed executed during the alleged interval. “If you can establish,” says Sir W. Wynne, “that the party afflicted habitually by a malady of the mind has intermissions, and if there was an intermission of the disorder at the time of the act, that being proved is sufficient, and the general habitual insanity will not affect it, but the effect of it is this--it inverts the order of proof and presumption; for, until proof of habitual insanity, the presumption is that the party agent, like all human creatures, was rational; but when an habitual insanity in the mind of the person who does the act is established, then the party who would take advantage of the fact of an interval of reason must prove it.” In civil cases the law recognises the validity of wills made during lucid intervals, and has even taken the reasonableness of a will as a proof of a lucid interval.

7. Have measures been taken by the culprit to escape punishment?

The classification of insanity adopted here is that given by Ray, and is sufficient for all practical purposes:

{ 1. Resulting from { congenital defect. { 2. Resulting from an { obstacle to the { Defective { _Idiocy_ { development of the { development { { faculties supervening { of the { { in infancy. { faculties. { { { { 1. Resulting from { { { congenital defect. { { { 2. Resulting from an { { _Imbecility_ { obstacle to the { { { development of the { { { faculties supervening { { { in infancy. INSANITY. { { Lesion of { { 1. Intellectual-- { the faculties { { (_a_) General. { subsequent { _Mania_ { (_b_) Partial. { to their { { 2. Affective-- { development. { { (_a_) General. { { { (_b_) Partial. { { { { { 1. Consecutive to mania, { { { or injuries of { { _Dementia_ { the brain. { { { 2. Senile, peculiar to { { { old age.

DEFECTIVE DEVELOPMENT OF THE FACULTIES

Under this heading may be included idiocy, cretinism, imbecility, feeble-mindedness, and moral imbecility.

=Idiocy= is congenital, and was defined by Esquirol thus: Idiocy is not a disease, but a condition in which the intellectual faculties are never manifested, or have never been developed sufficiently to enable the idiot to acquire such an amount of knowledge as persons of his own age, and placed in similar circumstances with himself, are capable of receiving. Idiocy commences with life, or at an age which precedes the development of the intellectual and affective faculties, which are from the first what they are doomed to be during the whole period of existence. Since the days of Esquirol, much improvement has been made in the care and treatment of the idiot; and it appears that he is capable of some, though in most cases slight, mental culture. The cases in which improvement takes place probably belong to imbecility, leaving the _idiot_ in the same condition as described by Esquirol.

=Cretinism= differs from idiocy in being endemic; it is also more curable, or at least more susceptible of improvement, than the latter. In the idiot the malady is congenital; the cretin, on the other hand, may to all appearances be free from disease for a time. “Every cretin is an idiot, but every idiot is not a cretin; idiocy is the more comprehensive term, cretinism is a special kind of it.” The enlarged thyroid gland, high-arched palate, and brown or yellow colour of the skin, are characteristic of the cretin. Local causes are at work in the production of cretinism; _e.g._ defective function of the thyroid gland.

The idiot is usually cunning, mischievous, and dirty in his habits.

The derivation of the word idiot, from the Greek, ἰδιώτης --_a private person_, or _an ill-informed ordinary fellow_--is peculiar. A person suffering from any form of mental unsoundness, and thereby rendered incapable of taking care of himself or of his property, was formerly called by English law “an idiot,” and this word was not infrequently joined with “fatuus” in old writs.

=Imbecility.=--This is a minor form of idiocy, and may or may not be congenital. It admits of considerable degrees of intensity. Imbeciles exhibit mental defection, rendering them incapable of managing themselves or their affairs, and imbecile children are incapable of being taught to do so.

=Feeble-mindedness= is a lesser degree of mental defection than imbecility. It may exist from birth or an early age. Such persons require care and control for the protection of themselves and others. They may be incapacitated from acquiring the knowledge imparted in ordinary schools.

=Moral imbeciles= exhibit moral defects which render them vicious in behaviour, and they often exhibit criminal tendencies, which are not affected by punishment.

CARE OF MENTALLY DEFECTIVE PERSONS

The Mental Deficiency Act of 1913 provides for their care. Such a person may be either sent to an institution or placed under special guardianship by the parent or guardian, if an idiot or imbecile; or by the parent when, though not an idiot or imbecile, the person affected be under the age of twenty-one years. If in addition to being a defective, the person is neglected, abandoned, or without means of support; or cruelly treated, guilty of a criminal offence, or liable to be sent to an industrial school, or under imprisonment, detained in an industrial school, inebriate reformatory, or institution for lunatics, or habitual drunkard within the meaning of the Inebriates Act; or in whose case proper notice has been given by the Local Education Authority; or who is in receipt of relief at the time of giving birth to an illegitimate child, or pregnant of such child.

=Certificates required.=--In the case of a parent or guardian who desires to place a mentally defective person under guardianship, _two medical certificates_ are necessary, one of which must be from a medical man approved by the Local Authority or Board. If the person be not an idiot or imbecile, the certificates must be signed by a Judicial Authority, after such inquiry as he thinks fit. A defective to be dealt with otherwise than by parent or guardian, is so under an order by a _Judicial Authority_ on a petition presented under the Act, an order of a _Court_ if guilty of a criminal offence, or an order of the Secretary of State if detained in prison, a criminal lunatic asylum, or reformatory.

The order of a Judicial Authority may be obtained by petition of any relative or friend, or an officer of the Local Authority authorised under the Act for the purpose. Two medical certificates must accompany the petitions, one of which must be signed by a medical man approved by the Local Authority or Board; or, when a medical examination cannot be carried out, a certificate to that effect must be presented, and a statutory declaration made by the petitioner and one other person, who may be one of the medical certifiers, stating the class to which the defective belongs. Upon receiving the certificates the Judicial Authority interviews the defective. When the petition is presented by a parent or guardian, the Judicial Authority, if satisfied, may issue an order for the defective to be placed in an institution or appoint a guardian. If the petitioner be not parent or guardian, consent in writing of one or other must be obtained, without which the order must not be made, unless the parent or guardian withhold their consent unreasonably or are not to be found. If the Judicial Authority be not satisfied, he may postpone the order, or refuse it.

When the order is made by a Court, the Court must be satisfied, on medical evidence, that the person is a defective.

Two medical certificates are necessary when the Secretary of State makes an order.

The order remains in force for a year, may be renewed for a second year, and then for periods of five years.

GENERAL SYMPTOMS OF INSANITY

The onset of insanity may be gradual or sudden. More commonly the onset is gradual, and manifested by alterations of emotion and conduct, which may for a considerable period precede any impairment of intelligence. Periods of depression may alternate with periods of excitement. Irritability and instability of temper manifest themselves, and lead relatives and friends to become suspicious of the change that is the herald of serious mental impairment. Lack of interest in environment, business, or the usual pleasurable pursuits, also a tendency to personal seclusion manifest themselves, and changeability of the affections, more often to those nearly related, are not uncommon. Sooner or later the capacity to conduct business and allied pursuits becomes enfeebled, and the power of judgment lessened; depression begets apprehension and a dread of impending ruin in this world or in the world to come. Marked indecision and vacillation of action is quite common. Delusions follow, mostly of persecution, in the form of attempts to cause ruin or poisoning. Delusions associated with the special senses are common, particularly of hearing, supposed voices urging the committal of certain actions, or expressive of derision; of vision, by which objects are seen which are non-existent; of taste, imparting the idea of poisoning; of touch and pain, invoking peculiar sensations; of smell, conveying the idea that food, the body, &c., exhale disgusting odours.

Associated with the onset of insanity, and remaining permanently, are three special distortions of perceptions--viz. _illusions_, _hallucinations_, and _delusions_. So long as the first two can be reasoned upon and rejected, judgment remains. At one or other time the afflicted person becomes so affected by them that they become realities, and are accepted as true and existent; then the judgment is perverted, and the person is said to suffer from a delusion.

_Illusions._--An illusion is a false perception, a perversion of the senses, a mockery, false show, counterfeit appearance. The false perception is, however, invoked by some external appearance.

_Hallucinations._--Hallucinations are perverted sensations and perceptions, for the production of which no external impulse is present. The person may complain of seeing horrible reptiles around, which are not present. So long as the reasoning faculties are capable of dispelling the alleged reality of the hallucination and rejecting it, it remains but an hallucination.

If, however, it becomes accepted as a reality and the person becomes obsessed thereby, it becomes a delusion.

_Delusions._--A delusion is a chimerical thought, an affection of the mind. It implies a disordered intellect. Delusions generally concern the insane person, his power, soul, &c. A delusion is a perverted idea of the mind in which there is belief in non-existent things or occurrences. Delusions may be based upon previous hallucinations, or arise out of erroneous conceptions.

MANIA

=Mania= is the result of a morbid condition of the brain, and to express which “the term raving madness may be used with propriety, as an English synonym for mania. All maniacs display this symptom occasionally, if not constantly, and in greater or less degree.” Like other diseases, mania observes the same pathological laws. There is a period of incubation, during which the true state of the patient is in most cases misunderstood, or not appreciated. Mental exaltation may exist from the first onset of the disease, or the attack may be ushered in by a stage of gloom or despondency. The general health shows signs of impairment, the liver becoming sluggish, and the bowels confined or relaxed. In some cases a febrile condition of the system is among the premonitory symptoms of an attack of mania. The physical health is not usually much affected during the paroxysm.

Dr. Conolly remarks that “even acute mania is not always accompanied by the ordinary external signs of excitement. It would seem as if we had yet to learn the real symptoms of cerebral irritation. Certainly, in recent cases of mania--cases which have lasted more than six weeks, and in young persons in whom I have seen the maniacal attack pass into dementia--I have known the most acute paroxysms of mania exist, rapid and violent talking, continual motion, inability to recognise surrounding persons and objects, a disposition to tear and destroy clothes and bedding, without any heat of the scalp or of the surface, without either flushing or paleness of the face, with a clean and natural appearance of the tongue, and a pulse no more than eighty or eighty-five.”

This may occur in some cases, but in the majority there is always some amount of physical derangement; the system, however, gradually becoming tolerant of the undue excitement to which it is subjected.

Following the classification adopted, Intellectual Mania will now be briefly considered under its two divisions--_General_ and _Partial_.

=General Intellectual Mania.=--By many medical writers general intellectual mania is divided into mania and melancholia. The mind in the former type of the disease is involved in the most chaotic confusion possible, and there is also considerable bodily derangement. The moral faculties become more or less affected, and the patient‘s social and domestic relations are greatly altered. At one time he is subject to violent fits of immoderate laughter, at another he is gloomy and taciturn; sometimes quiet and tractable, at others wild and excited, necessitating close confinement. He is haunted by wild delusions, which at times take entire possession of him, and under the influence of which he acts in the most extraordinary manner. In the latter--melancholia, or mania with depression--delusion may be absent, or, rather, for a time undetectable. The sufferer is gloomy, and troubled with unhappy thoughts, which sometimes lead him to self-destruction. He is sleepless, and rejects his food as unnecessary. He may be aroused for a short time by questions addressed to him, his replies to which are usually given correctly, most frequently in monosyllables; but the moment his questioner leaves him he relapses into his former gloomy state.

=Partial Intellectual Mania.=--The term _monomania_, first suggested by Esquirol, is now generally given to this variety of insanity. The patient, in the simplest form of this disorder, becomes possessed of some single notion, which is alike contradictory to common sense and to his own experience. Thus, he may fancy himself made of glass; and influenced by this idea, he walks with care, and in dread of being broken by contact with other bodies. In the case of an inmate at the City of London Asylum, the presence of a weasel in the stomach was stated by one woman. Esquirol mentions the case of a woman with hydatids in her womb, who believed that she was pregnant with the devil. Most of these strange fancies appear to be dependent on errors of sensation.

Monomaniacs are ready enough to declare their predominant idea; yet at times, and that without the occurrence of a lucid interval, they will as carefully conceal it. “In the simplest form of monomania, the understanding appears to be, and probably is, perfectly sound on all subjects but those connected with the hallucination. When, however, the disorder is more complicated, involving a longer train of morbid ideas, we have the high authority of Georget for believing that, though the patient may reason on many subjects unconnected with the particular illusion on which the insanity turns, the understanding is more extensively deranged than is generally suspected.”

MORAL MANIA

Pinel first drew attention to this form of madness. Pritchard defines it as “consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, and moral dispositions, without any notable lesion of the intellect or knowing and reasoning faculties, and particularly without any maniacal hallucinations.”

It is divided into--_General_ Moral Mania. _Partial_ Moral Mania.

=General Moral Mania.=--“There are many individuals,” says Pritchard, “living at large, and not entirely separated from society, who are affected in a certain degree with this modification of insanity. They are reputed persons of a singular, wayward, and eccentric character. An attentive observer will often recognise something remarkable in their manners and habits, which may lead him to entertain doubts as to their entire sanity; while circumstances are sometimes discovered on inquiry which add strength to this suspicion. In many instances it has been found that a hereditary tendency to madness has existed in the family, or that several relatives of the person affected have laboured under other diseases of the brain. The individual himself has been discovered to have suffered, in a former period of life, an attack of madness of a decided character. His temper and disposition are found to have undergone a change, or to be not what they were previously to a certain time; he has become an altered man, and the difference has perhaps been noted from the period when he sustained some reverse of fortune which deeply affected him, or the loss of some beloved relative. In other instances, an alteration in the character of the individual has ensued immediately on some severe shock which his bodily constitution has undergone. This has been either a disorder affecting the head, a slight attack of paralysis, or some febrile or inflammatory complaint, which has produced a perceptible change in the habitual state of his constitution. In some cases, the alteration in temper and habits has been gradual and imperceptible; and it seems only to have consisted in an exaltation and increase of peculiarities which were always more or less natural and habitual. Persons labouring under this disorder are capable of reasoning, or supporting an argument upon any subject within their sphere of knowledge that may be presented to them; and they often display great ingenuity in giving reasons for the eccentricities of their conduct, and in accounting for, and justifying, the state of moral feeling under which they appear to exist. In one sense, indeed, their intellectual faculties may be termed unsound--they think and act under the influence of strongly excited feelings; and persons accounted sane are, under such circumstances, proverbially liable to error, both in judgment and conduct.” (For interesting cases of this form of madness, see Ray‘s _Jurisprudence of Insanity_.)

=Partial Moral Mania.=--In the case of the unfortunate sufferers from this malady, one or two only of the moral powers are perverted.

This division admits of several subdivisions:--

_Kleptomania._--A marked propensity to theft. “There are persons,” says Rush, “who are moral to the highest degree as to certain duties, but who, nevertheless, lie under the influence of some vice. In one instance, a woman was exemplary in her obedience to every command of the moral law except one--she could not refrain from stealing. What made this vice more remarkable was, that she was in easy circumstances, and not addicted to extravagance in anything. Such was the propensity to this vice that, when she could lay her hands on nothing more valuable, she would often, at the table of a friend, fill her pockets secretly with bread. She both confessed and lamented her crime.”

_Pyromania._--This consists in an insane impulse to set fire to everything--houses, churches, and property of every kind and description.

_Erotomania and Nymphomania._--This is known as amorous madness, and consists in an inordinate and uncontrollable desire for sexual intercourse. The unfortunate victims of this disease often express the greatest disgust and repugnance for their conduct.

_Homicidal Mania_--In this form of madness the propensity to homicide is very great, and in most cases uncontrollable. In the case of the notorious Deeming, hanged in Australia in 1892 for the murder of his wife, an appeal was made from the finding of the Colonial Court by which he was tried to the Privy Council, on the ground of his being affected with homicidal mania. The plea was not sustained. (See the case of Henrietta Cornier, given by Pritchard, Ray, and others.)

The following suggestions may be of assistance in forming a diagnosis as to the existence or non-existence of this form of madness:--

1. Previous history of the individual.--_Melancholy, eccentric, morose, &c._

2. Absence of motive.--_Gain, jealousy, revenge, hatred, &c._

3. A number of victims are often sacrificed at one time.--_The murderer, on the other hand, seldom sheds more blood than is necessary for his success._

4. Proceedings of the murderer before and after the crime.--_Absence of attempts at concealment or escape on the part of the madman._

5. Character of the victims.--_Not infrequently, in the case of madmen, their victims are those whom, when sane, they loved most, and to whom they were most attached._

_Suicidal Monomania, or the Propensity to Suicide._--Much discussion has arisen on this subject. Suicide is not always the result of unsoundness of mind. Some, like M. Esquirol, are inclined to consider suicide as always a manifestation of insanity. In the present day, the dislike of coroners‘ juries to bring in any other verdict but that of “suicide whilst in a state of unsound mind” is proverbial.

MELANCHOLIA

This condition is associated with mental depression and delusions. In its simple form, marked depression of spirits, apprehension of evil, sleeplessness, loss of appetite, and impaired alimentation with constipation are evident.

Delusions of ruin, of the committal of acts contrary to the laws of God and man--“_the unpardonable sin_”--a marked inaptitude to carry on the ordinary duties of life, indecision, and often unutterable misery, are commonly exhibited. The delusions are fixed and may be multiple. They may comprise persecution, by friends or others; that things are happening which powerfully influence the person‘s life and body, or, as is often the case, concern religious matters, and everlasting punishment.

Suicidal tendencies are often present, and depend largely upon the misery associated with the condition. Melancholics often conceal this tendency, or may exhibit it in varied ways so as to hide the method which has been definitely decided upon. Thus a person so afflicted may be found in possession of poison at one time, a pistol at another, a knife at another, when the real intention is that of drowning. Thus it is necessary to keep an extremely careful watch on melancholics. Homicidal tendencies are not common. In some cases the melancholia is combined with _marked agitation._ The face depicts misery, the eyebrows raised, and the person moves about incessantly, picking up objects and replacing them, moaning and uttering the same phrases expressive of misery and hopelessness, wringing the hands, and rocking the body to and fro.

In other cases _stupor_ is predominant, and the person sits in silence and in the same attitude. Some resent interference, others are easily persuaded by their attendants to do certain acts, but when done relapse again into stupor. They manifest extreme apathy. Suicidal tendencies are a pronounced feature of such cases.

Melancholia and mania may alternate periodically, with lucid intervals intervening. The term _circular insanity_ has been applied to this alternate character of the disease.

DEMENTIA OR FATUITY

=Dementia= consists in a failure of the mental faculties, not congenital, but coming on during life. “A man,” says Esquirol, “in a state of dementia is deprived of advantages which he formerly enjoyed. He was a rich man who has become poor. The idiot, on the contrary, has always been in a state of want and misery.” In this state there is always more or less coherence, and maniacal paroxysms are not infrequent. In mania, incoherence may be present, but then it is characterised by sustained and violent excitement. In dementia, on the other hand, there is apparent torpor and exhaustion of the mental faculties. Closely allied to this form of mental unsoundness is that interesting disease known as “=general paralysis of the insane=,” or perhaps a better term, _progressive paralysis of the insane._ It is considered by some to precede the psychical derangement, a contrary opinion being held by others. General paralysis may accompany any of the forms of mental derangement, but it is generally preceded by a stage of melancholy. As the paralytic affection becomes more marked, there is a concurrent loss of memory and incapability of mental association, and all sense of duty is lost; the patient becomes careless as to his person, and dirty in his habits. He expresses himself as possessed of great property, and boasts of the wonderful deeds that he can or has accomplished. Gradually he sinks into a state of complete mental and physical decay. He cannot give expression to his thoughts, and has to be fed, the food being pushed into his mouth. The symptom which first attracts the attention, and which is perhaps the first order of sequence, is a modification in the articulation. “This is neither stammering nor hesitation of speech. It more closely resembles the thickness of speech observable in a drunken man. It depends upon loss of power over the co-ordinate action of the muscles of vocal articulation.” If the tongue be now examined, it will be found that when it is protruded it is not inclined to one side, but that it is tremulous, and is protruded and withdrawn in a convulsive manner. Griesinger was the first to call attention to the fact, and his statement has since been confirmed, “that this motory disorder is at the commencement not so much paralytic as convulsive in its nature.” The gait becomes unsteady, the patient walks stiffly, and stumbles over the slightest unevenness in the floor. Step by step the paralysis progresses, till at last the unfortunate sufferer takes to his bed, on which he may lie for months. Sometimes, especially during the earlier stages, he may suffer from terrible delusions, from maniacal paroxysms, or from epileptic fits, the latter possessing certain peculiarities. The tongue during the fit is seldom bitten, which is so commonly the case in epilepsy; and the convulsions are not so general, being limited more to one side than to the other. It is also remarkable that each fit is in most cases followed by an increase of the mental derangement.

Pritchard recognises four stages of dementia or fatuity:--

_First Stage._--Forgetfulness and impaired memory. This is common to old age. In most cases passing events produce little, if any, impression, whilst the past is remembered with tolerable freshness.

_Second Stage._--Incoherence and unreason, characterised by a total loss of the reasoning faculty.

_Third Stage._--Incomprehension. The person so affected is quite incapable of comprehending the meaning of the simplest question; and should he attempt to reply, his answer is generally remote from the subject.

_Fourth Stage._--Inappetency. The animal instincts are lost. The unfortunate sufferer lives, and that is all, being scarcely conscious of life. Organic life is all that is left.

DELIRIUM TREMENS. SIMPLE DELIRIUM. SOMNAMBULISM. SLEEP-DRUNKENNESS.

=Delirium Tremens.=--A temporary form of insanity, the result of excessive indulgence in spirituous liquors. The drunkard, under the effects of intoxication, “can derive no privilege from a madness voluntarily contracted, but is answerable to the law equally as if he had been in full possession of his faculties at the time” (1 Hale 32; Co. Litt. 247). The intoxication of the defendant may be taken as a mitigating circumstance, showing that the deed was unpremeditated. A person rendered incapable of using his reason by intoxication brought about by others, is not liable for his actions.

=Simple Delirium.=--Acts performed during attacks of certain diseases--fever, sunstroke, &c.--accompanied with delirium, do not render the individual liable to punishment; and wills made during the continuance of the disorder, if they contain no statement inconsistent with the known wishes and desires of the party during health, are valid, the law looking more to the good sense of the will as a proof of a lucid interval, than to the proved existence of such lucid interval.

=Somnambulist, &c.=--This is an abnormal mental state, closely allied to that artificially produced and known under the names of mesmerism, hypnotism, electro-biology, &c. It is commonly known as “sleep-walking.” In this condition the mind appears to become enslaved by one train of ideas to the exclusion of all others; the somnambulist, thus deeply bent on the accomplishment of a definite end, takes no heed of those objects which are in no way connected with the dominant ideas in his mind. Hence, he walks safely past dangers which, when awake, would disconcert his judgment and weaken his will. Somnambulism appears also to be closely connected with epilepsy. In 1878, a man named Fraser was tried in Glasgow for the murder of his child by beating it against the wall. He was acquitted on the ground of being unconscious of the nature of his act by reason of somnambulism. He had sprung from an epileptic and insane stock; his mother died in an epileptic fit, and some of his other relatives were insane. Thus it appears, if the somnambulism be proved, the accused is exonerated from any responsibility connected with the act for which he is being tried. So also, if a person be suddenly aroused from a deep sleep--_somnolentia_ or _sleep-drunkenness_--the question may be raised as to his responsibility for an act committed at the moment of awakening (R. _v._ Milligan). There cannot be a doubt but that if a person be suddenly aroused whilst dreaming, he may unconsciously commit acts, the outcome of his dream, which, unless the possibility of this condition be recognised, may entail severe punishment on him. This state is closely allied to that mental condition which sometimes occurs in epileptics immediately after a fit. But in this, as in cases of somnambulism, the facts of the case would have to be most carefully scrutinised.

The following hints may be of use as a guide in determining the responsibility or not of the accused:--

1. The person must be shown to have a general tendency to deep and heavy sleep, out of which he can only be aroused by a violent and convulsive effort.

2. Are there any circumstances which, happening before the individual went to sleep, would produce a train of disturbed thought not entirely composed by sleep?

3. Did the act occur during the usual hours for sleep?

4. Was the cause of the awakening sudden, and does the act bear throughout the character of unconsciousness?

5. What were the subsequent acts of the accused in relation to the deed? Did he try to evade responsibility? This must not have too much stress laid upon it, for the wretchedness of the sudden discovery may so overcome him, that he may seek to shelter himself from the consequences of an act for which he is legally but not morally responsible.

THE RESTRAINT OF THE INSANE AND DIRECTIONS FOR SIGNING MEDICAL CERTIFICATES.

No person can be put under restraint unless the conditions required by the Lunacy Acts are fulfilled. The Acts of Parliament for this purpose are the Lunacy Act of 1890 (53 Vict. c. 53) and that of 1891 (54 and 55 Vict. c. 65). Lunatics may be put under restraint by the following procedures, according to the particular case:--

Reception Order on Petition. Urgency Order. Order after Inquisition. Summary Reception Order. Order for Lunatics Wandering at Large, and for Pauper Lunatics. Reception Order by Two Commissioners.

=Reception Order on Petition.=--This is usually the procedure for private patients. The order for petition may be obtained from a specially appointed Justice of the Peace, Judge of County Courts, or Magistrate. A petition for the order must be presented to the Judicial Authority by the husband, wife, or relative of the alleged lunatic; if any other person apply, the reasons for this must be given. A petitioner must be twenty-one years of age or over, and must have seen the alleged lunatic _within fourteen days_ before its presentation. A _statement of particulars_ and two medical certificates must accompany the petition. The proceedings are private, and no one except the petitioner, the alleged lunatic, and any one person appointed by him, and the two medical men who have signed the certificates, may be present, unless by permission of the Judicial Authority. If the Judicial Authority be satisfied, he may make the order at once, even without seeing the patient, or he may appoint a time within seven days for inquiries and consideration. He may visit the alleged lunatic.

At the time of consideration of the petition he may adjourn it for not more than fourteen days, or he may make the order at the time. He may summon further witnesses, or dismiss the petition, giving his reasons for so doing in writing.

A reception order is valid for seven days from its date, unless the lunatic is certified by a medical man to be unfit for removal, when the order is extended until a medical certificate of fitness for removal is obtained, which is valid for three days.

The medical men signing the certificates must not be in partnership, as principal and assistant, or have any direct or indirect interest in the patient or his keeping (16 and 17 Vict. c. 96, sec. 4). They must make separate visits at different times for the purpose of examination. Each medical man must have examined the person within seven clear days before the presentation of the petition.

Each medical man must write clearly and in the proper place on the certificate: (1) The facts observed by himself as evidence of insanity, and (2) the facts observed by others as evidence of insanity. The name of his informant must be given.

One of the certificates should, whenever practicable, be under the hand of the usual medical attendant (if any) of the alleged lunatic. If not practicable, the reason must be given by the petitioner to the Judicial Authority.

Neither of the certifying medical practitioners may be the father or father-in-law, brother or brother-in-law, sister or sister-in-law, partner or assistant of the other of them.

Great care should be taken to follow carefully the marginal directions on the certificate form. The most trivial omission will invalidate the certificate. The omission of the name of the street and number of the house is sufficient to set it aside. A medical man should remember that, although his certificate may have passed the scrutiny of the Commissioners, it is liable to be made the subject of discussion in a Court of law, and in cross-examination he will have to support the statements therein made.

The following certificate properly filled up by Dr. Millar of Bethnal House Asylum, is given in his book on _Hints on Insanity_, and may be taken as an example of a correct certificate at that time, the present form being slightly different:--

MEDICAL CERTIFICATE PROPERLY FILLED UP

1. _Here set forth the_ I, the undersigned, _qualification entitling the_ _John Millar_, being a (¹) _person certifying to practise_ _Licentiate of the_ as a physician, surgeon, _or_ _Royal College of Physicians_, apothecary. _Edinburgh_,

2. Physician, surgeon, _or_ and being in actual practice as apothecary, _as the case_ a (²) _Physician_, hereby certify _may be_. that I, on the _third_ day of _November, One thousand eight hundred and eighty-eight_, at (³) 600 _Cambridge Road_, 3. _Here insert the street and_ _Bethnal Green_, in the county of _number of the house (if any_), _Middlesex_, separately from any or other like particular. other medical practitioner, personally examined _James Thompson, sen._, of 4. _Insert residence, and_ (⁴) 600 _Cambridge Road_, _profession or occupation_ _Bethnal Green_, _gentleman_, _(if any)._ and that the said _James Thompson, sen._, is a person (⁵) _of unsound 5. Lunatic, _or_ an idiot, mind_, and a proper person to be _or_ a person of unsound mind. taken charge of, and detained under care and treatment; and that I have formed this opinion upon the following grounds, viz.:-- 6. _Here state the facts._ 1. Facts indicating insanity observed by myself (⁶)-- _He is incoherent in his conversation, violent in his conduct, and quite unable to take care of himself_. 7. _Here state the information,_ 2. Other facts (if any) _and from whom._ indicating insanity communicated to me by others (⁷)-- _His son, James Thompson, jun_., _informs me that he has_ _threatened to commit suicide_, _and has twice attempted it_ _with a razor._ (Signed) Name--_JOHN MILLAR_.

Place of abode--_Bethnal House_, _Bethnal Green_.

Dated this _third_ day of _November_, _One thousand eight hundred and eighty-eight_.

The following are examples of “Facts” sent back to be amended by the Commissioners--the emendations in italics:--

1. Incoherence, perversion of facts, delusion. _Fancies that he possesses large amounts of money which people have secreted from him._

2. Says her sister lives in Chiselhurst, and she fears she is dying. She took great notice of my feet, and remarked that they were very large. Query by Commissioner--Are these delusions? _Her sister does not live at Chiselhurst, and is perfectly well; my feet are not large._

3. General restlessness of manner; considers himself heavily involved in debt to many thousands of pounds, _whereas his debts do not amount to a few hundreds_; says he has been ruined by the Government, _whereas he has only been dismissed from his appointment on account of his incapacity_; and he intends prosecuting the Admiralty for £5000 damages, _he having no real ground of action_. (This was twice sent back for correction, the first correction being--_By these statements I was satisfied that the patient was of unsound mind, and by his general conduct during examination._ Finally amended as given above.)

[Sidenote:

(_a_)--a Justice of the Peace for ____, _or_ His Honour the Judge of the County Court of ____, _or_ ____ Stipendiary Magistrate for ____.

(_b_) Full postal address and rank, profession, or occupation.

(_c_) At least twenty-one.

(_g_) Some day within 14 days before the date of the presentation of the petition.

(_h_) Here state the connection or relationship with the patient.

(_k_) Full Christian and surname.]

53 Vict. c. 5.--Sched. 2, Form 1.

PETITION FOR AN ORDER FOR RECEPTION OF A PRIVATE PATIENT

In the Matter of_______________________________ a person alleged to be of unsound mind.

_To_ (_a_)____________________________________ ____________________________________ ____________________________________

The Petition of_________________________________________ of (_b_)_________________________________________ _________________________________________

in the County of________________________________________

1. I am___________(_c_) years of age.

2. I desire to obtain an Order for the Reception of ________________________________________________ as a person of unsound mind, in the Haydock Lodge Licensed House, situate at Newton-le-Willows, Lancashire.

3. I last saw the said__________________________________ at______________________________________________________ on the (_g_)_______day of________________ 19_______

4. I am (_h_)_______________________________ of the said____________________________________________________

(or if the Petitioner is _not connected_ with or related to the or Patient, _state as follows_:)

I am not related to or connected with the said__________ ________________________________________________________

The reasons why this Petition is not presented by a relation or connection are as follows:

The circumstances under which this Petition is presented by me are as follows:--

5. I am not related to or connected with either of the persons signing the certificates which accompany this petition as (_where the petitioner is a man_) husband, father, father-in-law, son, son-in-law, brother, brother-in-law, partner, or assistant (_or where the petitioner is a woman_) wife, mother, mother-in-law, daughter, daughter-in-law, sister, sister-in-law, partner, or assistant.

6. I undertake to visit the said________________________ __________________________personally, or by some one specially appointed by me, at least once in every six months while under care and treatment under the order to be made on this petition.

7. A statement of particulars relating to the said_____________ ______________________________________accompanies this petition. _If it is the fact, add_: 8. The said_____________________ has been received in the Haydock Lodge Licensed House, Newton-le-Willows, under an Urgency Order dated the____________ _______________________________________________________________

The petitioner therefore prays that an order may be made in accordance with the foregoing statement.

=Signed= (_k_)_______________________________________

Date of Presentation of the Petition, this____________ day of___________________ 19_________

[Sidenote: (_a_) Name of Patient.

(_b_) To be signed by the petitioner.]

53 Vict. c. 5, s. 31.

When neither Certificate is signed by the Usual Medical Attendant.

I, the undersigned, hereby state that it is not practicable to obtain a Certificate from the usual Medical attendant of (_a_) __________________________________________________________________ for the following reason, viz.:--

(=Signed=) (_b_)______________________________ _______________ 19____________

Form 2.

STATEMENT OF PARTICULARS REFERRED TO IN THE ANNEXED PETITION

_If any particulars are not known the fact is to be so stated._

[Where the patient is in the petition or order described as an idiot, omit the particulars marked ►]

The following is a Statement of Particulars } __________________ relating to the said } __________________

Name of patient, with Christian name at } __________________ length } __________________

Sex and Age __________________

► Married, single, or widowed __________________

► Rank, profession, or previous occupation } __________________ (if any) } __________________

► Religious persuasion __________________

Residence at or immediately previous to } __________________ the date hereof } __________________

► Whether first attack __________________

Age on first attack __________________

When and where previously under care } __________________ and treatment as a lunatic, idiot, or } __________________ person of unsound mind } __________________

► Duration of existing attack __________________

Supposed cause __________________

Whether subject to epilepsy __________________

Whether suicidal __________________

Whether dangerous to others, and in } __________________ what way } __________________

Whether any near relative has been } __________________ afflicted with insanity } __________________

Names, Christian names, and full postal } __________________ addresses, of one or more relatives } of the patient } __________________

Name of the person to whom notice of } __________________ death to be sent, and full postal } __________________ address, if not already given } __________________

‡Name and full Postal Address of the } __________________ usual Medical Attendant of the Patient } __________________

‡When the Certificate is not signed by the usual Medical Attendant, the Certificate on the other side must be filled out.

[Sidenote: (_a_) _When the petitioner or person signing an urgency order is not the person who signs the statement, add the following

## particulars concerning the person who signs the statement._]

Signed (_a_)

_Name, with Christian Name at length_________________________________ _Rank, Profession or Occupation_ (_if any_)____________________ _How related to, or otherwise connected with the Patient_______________________________

53 Vict. c. 5. s. 7 (4).

=When a previous Petition has been dismissed=.

[Sidenote: (_a_) Name of Patient.

(_b_) Name of asylum, hospital, licensed house, or single charge.

(_c_) Justice of the Peace for ———, or Judge of County Court of ——, or Stipendiary Magistrate for ———]

I, the undersigned, hereby state that a former Petition for Reception of (_a_)___________________________________________ into (_b_)___________________________________________________ was presented to__________________________________________________

(_c_)________________________________________________________ in the month of________________ 19_______, and dismissed.

Herewith is a copy (furnished by the Commissioners in Lunacy) of the statement sent to them of the reasons for its dismissal.

Signed________________________________________ ________________ 19________

Note.--_This Copy is to be obtained from the Commissioners in Lunacy by the Petitioner at his own expense._

An Order for Reception of a Lunatic is to be obtained upon a private application by Petition to a Judge of County Courts, or Stipendiary Magistrate, or Metropolitan Police Magistrate, or specially appointed Justice of the Peace. The petition is to be presented, if possible, by the husband or wife, or by a relative (_i.e._ a lineal ancestor or lineal descendant, or lineal descendant of an ancestor not more remote than great-grandfather or great-grandmother) of the Lunatic, and is to be accompanied by a Statement of Particulars and two Medical Certificates on separate sheets of paper. One of the Medical Certificates accompanying the Petition must, if practicable, be by the usual Medical Attendant of the Lunatic; if not by him, the reason must be stated (see Form above). If a previous Petition has at any time been dismissed, the facts relating to its dismissal are to be stated in the fresh Petition (see Form above); and the Petitioner must obtain from the Commissioners in Lunacy a Copy of the Statement sent to them of the reasons for its dismissal, and present this copy with his Petition. The Reception Order (which will not remain in force for more than seven days after its date), the Petition, the Statement of Particulars, and the Medical Certificates must be sent to the Superintendent or Proprietor of the Asylum, Hospital, or House where the Patient is to be received.

[Sidenote: (_a_) _Insert residence of patient._

(_b_) County, city, _or_ borough, _as the case may be._

(_c_) _Insert profession or occupation, if any._

(_d_) _Insert the place of examination, giving the name of the street with number or name of house, or should there be no number, the Christian and surname of occupier._

(_e_) County, city, _or_ borough, _as the case may be._

(_f_) _Omit this where only one certificate is required._

(_g_) A lunatic _or_ an idiot, _or_ a person of unsound mind.

(_h_) _If the same or other facts were observed previous to the time of the examination, the certifier is at liberty to subjoin them in a separate paragraph._

(_i_) _The names and Christian names (if known) of informants to be given, with their addresses and descriptions._

(_k_) _Strike out this clause in case of a patient whose removal is not proposed._

(_l_) _Insert full postal address._]

53 Vict. c. 5.--Sched. 2, Form 8.

CERTIFICATE OF MEDICAL PRACTITIONER

In the Matter of_________________________________________

of (_a_)_____________________________________________________

in the (_b_)_____________________ of_________________________

(_c_) _______________________________________________________

_______________________________________an alleged lunatic.

I, the undersigned, ______________________________________________ do hereby certify as follows:

1. I am a person registered under the Medical Act, 1858, and I am in the actual practice of the medical profession.

2. On the_______________________ day of ________________ 19__ at (_d_) _______________________________________________ in the (_e_)___________________ of _____________________ _________________(separately from any other practitioner) (_f_) I personally examined the said ___________________________________ and came to the conclusion that ____ he is (_g_) ____________ and a proper person to be taken charge of and detained under care and treatment.

3. I formed this conclusion on the following grounds, viz.:--

(_a_) Facts indicating insanity observed by myself at the time of examination (_h_), viz.:-- _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

(_b_) Facts communicated by others (_i_), viz.: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

4. The said __________________________________________________ appeared to me to be[18]..................in a fit condition of bodily health to be removed to an asylum, hospital, or licensed house (_k_).

5. I give this certificate having first read the section of the Act of Parliament printed below.

=Signed=____________________________________ of (_l_)_____________________________

=Dated= this __________ day of ________ 19__

[18] _Or_ not to be.

[Sidenote: Lunacy 8.

53 Vict. c. 5, ss. 4, 11, 16, 28, 29.]

_Extract from section 317 of the Lunacy Act, 1890._

Any person who makes a wilful misstatement of any material fact in any medical or other certificate or in any statement or report of bodily or mental condition under this Act, shall be guilty of a misdemeanour.

[Sidenote: (_a_) A Justice for --, specially appointed under the Lunacy Act, 1890, _or_ the Judge of the County Court of --, _or_ the Stipendiary Magistrate for--

(_b_) _Address and occupation._

(_d_) _Name of petitioner._]

53 Vict. c. 5.--Sched. 2, Form 3.

ORDER FOR RECEPTION OF A PRIVATE PATIENT, TO BE MADE BY A JUSTICE APPOINTED UNDER THE LUNACY ACT, 1890, JUDGE OF COUNTY COURTS, OR STIPENDIARY MAGISTRATE

I, the undersigned _______________________________________________ being (_a_) _________________________________________________ __________________________________________________________________ upon the petition of _____________________________________________ of (_b_) ____________________________________________________ in the Matter of _________________________________________________ a person of unsound mind, accompanied by the Medical Certificates of _______________________________________________________________ and ______________________________________________________________ hereto annexed, and upon the undertaking of the said (_d_) __________________________________________________________________ to visit the said ________________________________________________ personally or by some one specially appointed by the said (_d_) __________________________________________________________________ once at least in every six months while under care and treatment under this Order, hereby authorise you to receive the said _____________________________________________________________ as a patient into your Licensed House (_e_).

=And= I declare that I have [_or_ have not] personally seen the said ____________________________________________________ before making this Order.

=Dated= this __________________ day of ________________ 19___

=Signed= (_a_) _________________________

_A Justice for _________________________________ appointed under the above-mentioned Act [or the Judge of the County Court of_____________________ or a Stipendiary Magistrate_].

=Urgency Orders.=--Where it is urgent that an alleged lunatic (not a pauper) must be put under restraint as soon as possible, he may be received upon an _urgency order_, without petitioning a Judicial Authority, accompanied by a _statement of particulars_ and _one medical certificate_. The order should be made by the husband, wife, or a relative of the alleged lunatic; if this be not possible, the reasons must be stated. It may be signed before or after the medical certificate, and before or after a petition order has been made. If before, it must be noted in the petition; if after, a copy must accompany the petition. No person may sign an urgency order if under twenty-one years of age, and must have seen the alleged lunatic within two days before the date of the order.

The urgency order remains in force seven days from its date, during which period the procedure for a “Judicial Order on Petition” is carried out. If the petition has been presented and the order is for some reason or other deferred, then the urgency order remains in force. The medical examination for certification must have been made not more than two days before reception, and reasons must be given why “it is expedient” that the alleged lunatic should be put under control “forthwith.”

[Sidenote: (_a_) House, _or_ hospital, _or_ asylum, _or_ as a single patient.

(_b_) _Name of Patient._

(_c_) Lunatic, _or_ an idiot, _or_ a person of unsound mind.

(_d_) _Some day within two days before the date of the order._

(_e_) Husband, wife, father, father-in-law, mother, mother-in-law, son, son-in-law, daughter, daughter-in-law, brother, brother-in-law, sister, sister-in-law, partner, or assistant.

(_If not the husband or wife, or a relative of the patient, the person signing to state as briefly as possible_--1. _Why the order is not signed by the husband or wife, or a relative of the patient._ 2. _His or her connection with the patient, and the circumstances under which he or she signs._)

(_f_) Superintendent of ____ the ____ asylum, ____ hospital _or_ resident licensee of the ____ house (_describing the asylum, hospital, or house by situation and name_.)

Lunacy, Nos. 4 & 2.

(33 Vict. c. 5, s. 11.)]

53 Vict. c. 5.--Sched. 2.

FORM OF URGENCY ORDER FOR THE RECEPTION OF A PRIVATE PATIENT, WITH MEDICAL CERTIFICATE AND STATEMENT ACCOMPANYING URGENCY ORDER

Forms 4, 2, 8 and 9.

I, the undersigned, being a Person Twenty-one years of age, hereby authorise you to receive as a Patient into your (_a_) House (_b_) _________________________________________________ __________________________________________________________________ as a (_c_) __________________________________whom I last saw at ____________________________________________________________________ on the (_d_) __________________ day of_______________ 19____

I am not related to or connected with the Person signing the Certificate which accompanies this Order in any of the ways mentioned in the Margin. (_e_) Subjoined (_or_ annexed) hereto is a Statement of Particulars relating to the said __________

(=Signed=) _____________________________________ _Name and Christian Name_ } _______________________________ _at Length_ } _______________________________ _Rank, Profession, or Occupation_ } _______________________ _(if any)_ } _______________________ _Full Postal Address_ _____________________________________ _How related to or connected_ } ___________________________ _with the patient_ } ___________________________

=Dated= this _______________ day of __________ 19____

STATEMENT OF PARTICULARS REFERRED TO IN THE ANNEXED ORDER

_If any Particulars are not known, the Fact is to be so stated._

(Where the patient is in the petition or order described as an idiot, omit the particulars marked ►.)

The following is a Statement of Particulars } ____________________ relating to the said } ____________________

Name of Patient, with Christian Name } ___________________________ at length } ___________________________

Sex and Age __________________________

Married, Single, or Widowed ______________________________________

► Rank, Profession, or previous Occupation } _____________________ (if any) } _____________________

► Religious Persuasion ___________________________

Residence at or immediately previous } ___________________________ to the date hereof } ___________________________

► Whether First Attack ________________ Age on First Attack ________________

When and where previously under Care } ________________________ and Treatment as a Lunatic, Idiot, or } ________________________ Person of Unsound Mind } ________________________

► Duration of existing Attack ____________________________________

Supposed Cause ___________________________________________________

Whether subject to Epilepsy ______________________________________

Whether Suicidal _________________________________________________

Whether dangerous to Others, and in } ____________________________ what way } ____________________________

Whether any near Relative has been } _____________________________ afflicted with Insanity ... ... } _____________________________

Names, Christian Names, and full Postal } ________________________ Addresses of one or more Relatives } ________________________ of the Patient } ________________________

Name of the Person to whom Notice } _________________________ of Death to be sent, and full Postal } _________________________ Address, if not already given } _________________________

Name and full Postal Address of the } __________________________ usual Medical Attendant of the } __________________________ Patient } __________________________

=Signed= _________________________________________

When the Petitioner or person signing an Urgency Order is =NOT= the person who signs the Statement, add the following particulars concerning the person who signs the Statement.

Name, with Christian name at length ______________________________

Rank, profession, or occupation (if any) _________________________

How related to or otherwise connected } __________________________ with the patient } __________________________

[Sidenote: (_a_) _Insert residence of patient._

(_b_) County, city, _or_ borough, _as the case may be._

(_c_) _Insert profession or occupation, if any._

(_d_) _Insert the place of examination, giving the name of the street, with number or name of house, or should there be no number, the Christian and surname of occupier._

(_e_) County, city, _or_ borough, _as the case may be._

(_f_) _A lunatic_, an idiot, _or_ a person of unsound mind.

(_g_) _If the same or other facts were observed previous to the time of the examination, the certifier is at liberty to subjoin them in a separate paragraph._

(_h_) _The names and Christian names (if known) of informants to be given, with their addresses and descriptions._

Lunacy, Nos. 8 & 9.

(53 Vict. c. 5, ss. 11, 28, 29, 32 and 33.)]

53 Vict. c. 5.--Sched. 2, Form 8.

CERTIFICATE OF MEDICAL PRACTITIONER

In the Matter of _________________________________________________ of (_a_) ____________________________________________________ in the (_b_)________________________ of _____________________ (_c_) _______________________________________________________ an alleged lunatic.

I, the undersigned _______________________________________________ do hereby certify as follows:--

1. I am a person registered under the Medical Act, 1858, and I am in the actual practice of the medical profession.

2. On the ________________ day of ___________________ 19 ______ at (_d_) ______________________________________________ in the (_e_) ________________ of ______________________ I personally examined the said _____________________________ and came to the conclusion that ____ he is (_f_)_______ and a proper person to be taken charge of and detained under care and treatment.

3. I formed this conclusion on the following grounds, viz.:--

(_a_) Facts indicating Insanity observed by myself at the time of examination (_g_), viz.:-- __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

(_b_) Facts communicated by others (_h_), viz:-- __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

[Sidenote: (_i_) _If an urgency certificate is required, it must be added here.--Form No. 9._

(_k_) _Strike out this clause in case of a private patient whose removal is not proposed._

(_l_) _Insert full postal address._

53 Vict. c. 5.--Form 9.]

(_i_) STATEMENT ACCOMPANYING URGENCY ORDER

I certify that it is expedient for the welfare of the said ________ _______________________ (_or_ for the public safety, _as the case may be_) that the said ____________________________________ should be forthwith placed under care and treatment.

My reasons for this conclusion are as follows: ____________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

4. The said _______________________________________________________ appeared to me to be [‡ _____________] in a fit condition of bodily health to be removed to an asylum, hospital, or licensed house (_k_). (‡) Or not to be.

5. I give this certificate having first read the section of the Act of Parliament printed below.

=Dated= this ________________ day of _________________________ One thousand nine hundred and ______________

(=Signed=) _____________________________ of (_l_) _____________________________

_Extract from section 317 of the Lunacy Act, 1890._

Any person who makes a wilful misstatement of any material fact in any medical or other certificate, or in any statement or report of bodily or mental condition under this Act, shall be guilty of a misdemeanour.

=Orders after Inquisition.=--This constitutes a legal investigation as to whether or not a person is capable of managing his or her own affairs, and whether restraint is necessary. It is conducted before a judge, with a jury if the alleged lunatic demand one, unless the judge is satisfied by personal examination that the lunatic is not mentally competent to understand the demand for a jury. In such a case the medical man is only concerned as a witness.

According to circumstances the alleged lunatic may be kept under restraint, or remain at liberty with the control of his or her affairs under a “Committee of Estate”; or, if declared sane, set free and with control of his estate.

=Summary Reception Orders.=--When a lunatic is not under proper control, and if without relations or friends, and there be no one who will sign a petition for detention, or when a lunatic is uncared for, cruelly treated, and is found so by a medical practitioner, his duty is to inform a constable, relieving officer, or overseer of the parish of the fact. The official will then make a statement on oath to a Judicial Authority, who will direct two medical practitioners to make the necessary examinations, and if satisfied he will issue an order for the removal of the individual to an asylum. The procedure followed will then be the same as for a “petition for reception.” Under a summary reception order the Judicial Authority may place the person under the care of a relation or friend, or the visitors of the asylum in which the person is intended to be, or is placed.

=Lunatics Wandering at Large.=--Every constable, relieving officer, or overseer of a parish who knows of a person, whether pauper or not, who is deemed to be a lunatic and wandering at large, shall apprehend and take such person before a Justice, or if the Justice receive information on oath, he may have the person apprehended and brought before him. The Justice has the person medically examined, and if certified a lunatic to the satisfaction of the Justice, he may issue an order for detention; if the medical man certify that the person is not fit for removal, the removal is postponed until the person is certified fit for it.

The above proceedings are not necessary if it be considered a matter of public safety and for the good of the alleged lunatic that immediate detention be carried out. The constable, relieving officer, or overseer of the parish may remove such person to the workhouse of the union in which the person is, and detain him for not more than three days. Before the expiration of that time the necessary proceedings under the Lunacy Act must be taken.

=Reception Order by two Commissioners.=--Any two or more Commissioners in Lunacy may visit a pauper lunatic or an alleged lunatic not detained in a workhouse or lunatic asylum, and if satisfied after certification by a medical man that the person is a lunatic, order removal to an asylum.

=Pauper Lunatics.=--A medical officer of a Poor Law Union who has knowledge that a pauper within his district is alleged to be a lunatic, shall notify the relieving officer or overseer of the parish where the pauper resides of the fact, who within three days shall notify a Justice, who will interview the alleged lunatic and call in a medical practitioner to examine and certify. If the Justice be satisfied that the person be a lunatic, he makes an order for removal to an asylum. One medical certificate only is necessary.

=Escape of Lunatics.=--An escaped lunatic may be retaken at any time within fourteen days without a fresh order.

=Discharge of Lunatics.=--The reception order remains in force for periods of one, two, and three years, and then for periods of five years. At the end of any of these periods the Lunacy Commissioners may continue the detention of the lunatic, if satisfied by certification from the medical man of the institution, or the usual medical attendant of the lunatic, that the patient remains of unsound mind and further detention is necessary.

The petitioner of the reception order may request the discharge of a patient. The discharge may be refused if the medical man in charge certifies the lunatic dangerous and unfit to be at large, unless two of the visitors to the asylum or the Commissioners visiting the asylum or house give their consent in writing.

Two Commissioners--one medical, the other legal--may order the discharge of any patient.

When a patient recovers, the medical attendant of the institution notifies this to the petitioner or person responsible for the payment on account of the patient. Should the patient not be removed within seven days of such notice, the patient may be discharged “forthwith.”

PROCEDURE IN SCOTLAND

Idiots and imbeciles under eighteen years of age may be received into training schools without the legal procedure which obtains in England and Wales. They are sent to these institutions as lunatics, however, under the usual legalities, in order that the Government grant may be obtained. When over eighteen years of age, if sent to institutions other than training schools, they are classed as lunatics, and the necessary legal procedure is followed.

=Insane persons whose malady is not confirmed= may be cared for privately for a period not exceeding six months. The certificate of one medical practitioner only is required.

_Insane persons_, pauper or not, can be placed in an asylum by order of the Sheriff, by petition and two medical certificates. The inspector of the poor acts as petitioner for paupers.

In cases of urgency a _certificate of emergency_ from one medical practitioner is required, along with a request from the petitioner, to the superintendent of the asylum.

A person who is _prodigal_ or _facile_ can be restrained from alienating his property by guardians appointed by the Court.

When a lunatic is found to be incapable of administering his or her estate, the Court appoints a Committee of Estate.

PROCEDURE IN IRELAND

The procedure differs in pauper and private cases.

=Pauper patients, not dangerous.=--In order to detain such a pauper there must be a declaration of insanity and destitution, with the names and addresses and descriptions of two relatives of the person, given before a magistrate. A magistrate and a clergyman or poor-law guardian must certify that they have personally inquired into the case. One medical certificate is necessary. The applicant must remove the patient when called upon.

=Paying patients who are not dangerous=, for admission to a district asylum, are under more stringent regulations. A declaration that they are unable to pay the expenses necessary for support in a licensed house must be made before a magistrate; further, that there is no friend who can undertake this; and a statement of the length of time the patient has resided in the country. A magistrate and clergyman must certify that they have investigated the case. One medical certificate must be signed by two practitioners. A guarantee for the payment must be given, and also to remove the patient when called upon. The sanction of an inspector of lunatics must be given.

For admission into licensed houses, charitable institutions, and single care, an order by a relative or connection of the lunatic is required with two medical certificates, unless urgent, when one is sufficient, but a second must follow within fourteen days.

LIABILITIES OF PERSONS SIGNING LUNACY CERTIFICATES

A medical practitioner is bound to certify as to the sanity of a person. If, however, he undertakes to fill up the certificates necessary for the detention of an alleged lunatic, he becomes responsible to the authorities for the correctness of the certificates, and if he make a wilful misstatement of facts he is guilty of a misdemeanour. The medical practitioner may have an action brought against him by the lunatic when recovered or discharged. The most vindictive feelings may be entertained against the medical man. In such a case, if the medical man proves his “good faith” and the exercise of “reasonable care” in his examination and certification, he receives the protection of the Court.

LIABILITIES OF PERSONS RECEIVING INSANE PATIENTS

In the case of Nottidge _v._ Ripley and Nottidge, the Lord Chief Baron having been understood to intimate an opinion that no person ought to be so confined unless he is dangerous to himself or others, the Commissioners pointed out that the scope of the Lunacy Acts is not thus limited. They said:

“The object of these Acts is not, as your Lordship is aware, so much to confine lunatics, as to restore to a healthy state of mind such of them as are curable, and to afford comfort and protection to the rest. Moreover, the difficulty of ascertaining whether one who is insane be dangerous or not is exceedingly great, and in some cases can only be determined after minute observation for a considerable time.

“It is of vital importance that no mistake or misconception should exist, and that every medical man who may be applied to for advice on the subject of lunacy, and every relative and friend of any lunatic, as well as every magistrate and parish officer (each of whom may be called upon to act in cases of this sort), should know and be well assured that, according to law, any person of unsound mind, whether he be pronounced dangerous or not, may legally and properly be placed in a county asylum, lunatic hospital, or licensed house, on the authority of the preliminary order and certificates prescribed by the Acts.

“Upon the whole, it appears that the power to restrain and confine a lunatic is limited at common law to cases in which it would be dangerous, either as regards others or himself, for the lunatic to be at large; but that the power to place and detain a lunatic in a registered hospital or licensed or other house, under an order and medical certificates duly made and obtained in accordance with the Lunacy Acts, is not so limited.”

The terms of the Lunacy Act, 1890, are as follows:

“Subject to the exceptions in this Act mentioned a person shall not be received or detained as a lunatic, as a single patient, unless under a reception order by a judicial authority.” “Every person who, except under the provisions of the Act, receives or detains a lunatic or an alleged lunatic in an institution for lunatics, or for payment takes charge of, receives to board or lodge, or detains a lunatic or alleged lunatic in an unlicensed house, shall be guilty of a misdemeanour, and in the latter case shall also be liable to a penalty not exceeding fifty pounds.” “Except under the provisions of this Act, it shall not be lawful for any person to receive or detain two or more lunatics in any house, unless the house is an institution for lunatics or a workhouse.” “Any person who receives or detains two or more lunatics in any house except as aforesaid shall be guilty of a misdemeanour.”

It is therefore unlawful to receive a lunatic or alleged lunatic except by reception order. Only one can be received into a private house, and a reception order is required. No medical man should receive a lunatic into residence without the necessary reception order. All the statutory regulations are demanded for a single case, and the private house is subject to visitation and inspection.

It is also important to remember that if any one receive a person not insane at the time, but who subsequently becomes insane, he renders himself liable to prosecution, unless he procure the necessary medical certificates and order (R. _v._ Wilkins).

=Is a Lunatic a competent Witness?=--Mr. Fitzjames Stephen maintains (_Criminal Law_) that madmen are competent witnesses in relation to testimony as in relation to crime. If they understand the nature of an oath, and the character of the proceedings in which they are engaged, they are competent witnesses whatever be the nature or degree of their mental disorder. An idiot shall not be allowed to give evidence (Co. Litt. 6 b; Gilb. Ev. 144); a lunatic during a lucid interval may do so (_Id. Com. Dig. Testm._ {A}). When a lunatic is tendered as a witness, it is for the judge to examine and ascertain whether he is of competent understanding to give evidence, and is aware of the nature and obligation of an oath; if satisfied that he is, the judge should allow him to be sworn and examined (R. _v._ Hill, 2 Den. 255; 20 L.J. [M.C.] 222).

=The Civil Rights of Lunatics.=--If an individual be suffering from such mental disease as to render him incompetent to manage his own affairs, the law steps in to protect him and his property from injury. But the power so used does not necessarily imply that he is deprived of his personal freedom, but merely such restraint as is necessary for his protection.

Many lunatics, under the protection of the Court, live in their own houses with large establishments. A person so protected by the law is said to be subject to an “interdiction.” In these cases a commission is usually granted by the Court of Chancery, and a writ known under the name of “_de lunatico inquirendo_” issued, after certain legal matters of detail are settled, and affidavits from medical men certifying to the insanity of the party have been filed.

The tests of insanity in these cases differ from those required in criminal cases, where the knowledge of right from wrong is imperatively demanded. The mental defect must not be the result of ignorance or want of education, and at one time commissions were only issued when it was shown that lunacy and idiocy alone existed, imbecility or mere weakness of mind not being deemed sufficient to deprive a man of his civil rights, or to place him under the protection of the Court.

To so great an absurdity did this lead, that the man suffering from a delusion sufficient to be comprehended under the legal term “lunacy” was protected, whereas the feeble-minded were left without interference, though needing it more. The cost of these commissions sometimes reached almost fabulous sums. The expense has been somewhat lessened by recent enactments, and the process simplified--the Lord Chancellor having it in his power to direct an inquiry before two Commissioners, thus dispensing with a jury. (See the 16 and 17 Vict. c. 70, and 25 and 26 Vict. c. 86.)

In Scotland, however, the law is far more simple. The cognition proceeds on a _brieve_ or writ addressed to the Lord President of the Court of Session, and directs him to inquire “whether the person sought to be cognosced is insane, who is his nearest agnate, and whether such agnate is of lawful age.” “And such person shall be deemed insane if he be furious or fatuous, or labours under such unsoundness of mind as to render him incapable of managing his affairs.” “The trial is before a judge of the Supreme Court and a special jury. If the insanity be proved, the nearest agnate--relation by the father‘s side--is by law entitled to the guardianship.” No one not a near relative can institute these proceedings.

In Scotland also, the trial by jury may be avoided by applying by petition to the Court of Session for the appointment of a judicial factor or _curator bonis_. Of this appointment the alleged lunatic is informed, which, if he please, he may oppose; medical evidence is received, and on this the Court rests its decision--the usual course being to remit the case to some competent person to make inquiry, take evidence, and report. The Commissioner is usually the Sheriff.

=Examination of the Insane.=--A few words of caution need here be said. Medical men will consult their own dignity and that of their profession by remembering that in cases of alleged insanity, as in fact in all other cases when their opinion is sought, they are not justified in taking sides. Their evidence will be the more valuable in proportion to the care they take in examining into the facts of the case, and the good sense and judgment shown in their examination of the patient. To distinguish between the mistakes, the result of ignorance and want of education, and those the result of a feeble mind, is of primary importance. It is no sign of insanity in an uneducated farmer that he knows not the _pons asinorum_. All cases should be tested by considering the surroundings and possible degree of culture of a person placed under like conditions as the party under examination. Has he shown himself capable of an average amount of culture? or is his mental condition inferior to what one might legitimately expect under the influences to which he has been subjected? The medical examiner should also direct his attention to this important point, setting aside all legal and medical theories of insanity, viz.--“Is the case of _such mental disorder_ as to create _an incapacity for managing affairs_.”

TESTAMENTARY CAPACITY

A medical practitioner may be called upon to give evidence as to the capacity of a testator to make a valid will. An ordinary person witnessing a will does so to fact only, but if a medical man do so it implies that he was of the opinion that the testator was fit to make a will and of a sound and disposing mind. In making an examination of a person for fitness to make a will, the medical man must endeavour to find out if the testator understands the nature of his action, and all the details associated with it; also if he knows the nature and amount of his property, and the claims or otherwise of those who may become beneficiaries under it. Further, has he such a delusion as may influence his will in disposing of his property, and bring about a disposal of it which, if the mind had been sound, would not have been made.

A person may have a delusion or delusions without interfering with the making of a will. If the “disposing mind” be left intact, testamentary capacity is upheld. In severe illness and old age the mind may be so disturbed, without true insanity being present, that a person is rendered incapable of making a will. In all such cases the medical man should be sure of his ground before granting, if requested, that the patient is capable or otherwise. It is a good plan, when examining a patient as to testamentary capacity, to have the will produced, and privately read it out to the person and ask if it be correct, then to have the person repeat the dispositions of the will, and see if they coincide with the contents of the document.

People who are aphasic may make wills which are valid. Difficulties arise in cases of sensory aphasia.

RESTRAINT OF HABITUAL DRUNKARDS

An habitual drunkard, as defined by law, is “a person who, not being amenable to any jurisdiction in lunacy, is notwithstanding, by reason of habitual intemperate drinking of intoxicating liquor, at times dangerous to himself or herself, or to others, or incapable of managing himself or herself or his or her own affairs.”

Before placing such a person under restraint in a licensed retreat the person‘s consent must be obtained. The patient must make an application to a Justice of the Peace, and supported by a declaration from two persons stating that the applicant is an habitual drunkard within the meaning of the Act. If the justice be satisfied, he can make out an order for detention. The order is valid for any time mentioned in the application not exceeding two years. The patient can be detained, forcibly if necessary, and if escaped may be arrested and taken back.

SECTION II

TOXICOLOGY