The position of the medical profession in regard to certificates of mental unsoundness and civil incapacity / by T.S. Clouston.

  • Clouston, T. S. (Thomas Smith), 1840-1915.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: The position of the medical profession in regard to certificates of mental unsoundness and civil incapacity / by T.S. Clouston. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    personal liberty is not interfered with quoad lunacy, except on a magistrate’s authority, that the papers are in statutory form, that everything is bona fide, and that the medical men who sign are on the Medical Register. It secures that amount of publicity in the whole transaction which is needed to give the public con- fidence in the working of the laws. But while that is my opinion in regard to the sheriffs non- competency to review and judge as to the “ facts stated in the medical certificates, I am not to be taken as implying that there- fore those facts are unimportant, or should be carelessly dealt with by men in signing their lunacy certificates. On the contrary, I would put them on higher ground than that they should be merely sufficient to “ pass the sheriff.” I would urge on my professional brethren that they should be sufficient to satisfy the more accurate demands of science. I would say that each case should be so care- fully examined into, and the reasons for coming to the decision to certify the patient so clearly arrived at in one’s own mind, that the writing down of the “ facts” would be a mere formulation of the most important reasons for the conclusion already come to. “ Is the patient insane?” “What evidence is there?” “What kind of insanity does he labour under?” “Is he a proper person to be detained under care and treatment?” “Why should he be so detained ?” If one is able to answer these questions clearly in one’s own mind, there is usually little difficulty in filling in the “ facts.” I would say that the chief things which require asylum treatment and imply medical certificates are danger to the patient or others without proper means of obviating such danger, disturbance of the public peace, offences against public decency, the necessity for care and treatment which cannot otherwise be got, the presence of such symptoms as can only be properly treated in a hospital for the iusane, the failure of treatment otherwise, and the deliberate medical opinion that hospital treatment is best for the patient. As we all know, all sorts of considerations—social, monetary, and domestic—must be taken into account in deciding the question. When the certificate is being prepared, we certainly cannot do so too carefully: one should look at the directions on the margin in each case, and read over every certificate before it leaves one’s hands. To get “facts” to put down, one should first think of the marked insane delusions, then of incoherence of speech, then of suicidal or dangerous occurrences, then of shouting or outrageous conduct, then of incapacity to understand questions or to answer them sensibly, then of insane reasons assigned for conduct, then of changes from the natural character and conduct, then of abnormali- ties of appearance, facial expression or manner, then of negative signs, such as taciturnity and insensibility to impressions. Quote the patient’s words, if possible. If we put our facts down in a pithy, dogmatic way, using definite but non-professional expressions, and if the process of diagnosis with subsequent certification is