An Address ON THE EXAMINATION AND CERTIFICATION OF MENTAL PATIENTS: Delivered before the Oxford Medical Society
Authors: J. Neil
Journal: BMJ (1908)

THE law of England provides that no shall deprivedof liberty and detained under care treatment, on ther ground oi insanity, without either formal certificates by registered medical .practitioners, the effect that the person proposed to be so detained insane.This legalprovision throws on the members the medical profession a duty always charged consequences momentous to the patient, -and difflbult, sometimes even dangerous; to certifr.The following remarks are restricted to ther examination and diagnosis requiredLby.the statutory certificate, the writing of the certificate, Everything is intentonally avoided.In physical disease the diagnosis depends chiefly inferences drawn.from data furnished to physician -thedirect exercise of his senses on the patient.In mental disease.on the other turns, a great extent, on the correct appreciation of conduct.Hencethe greater depeindence of the upon information supplied to him by othes.case pneumonia the diagnosis does not depend as related, by the patient or his friends; case of.obscure delusions, or morbid moral perversion, cian might for a$long time search in vain unless search were 'guided, by what had been told to previous conduct and conversation of hiS chief criterion of mental soundness and condut.; and conduct being infinitely various.kinds, it follows that the symptoms must also be definitely various.It. follows the examination of mental patients cannot process so systematic and methodical of those who.are suffering from bodily illness.. learned judges and other exponents, of tained that the diagnosis of insanity require.mednical knowledge at all, but is merely they call "common sense."But, it is possible to do something to- inherent difficulties and to reduce the a mental case to a comparatively orderly the purpose of certification the law only wnow if the patient is insane.It is obvious that.for,purposes we should want to know a great this.We should want to know the the patient-whether this is the first attack is its supposed cause, the clinical variety insanity, the accompanying physical.symptoms the law cares for none of these things, tion regarding them.From the legal mania, melancholia, paranoia, and the isame, and their etiology and prognosis Only one question is asked-or to speak with perhaps strict accurac,.two questions included one-namely,.Is this person insane, and is he proper deaineaedundet care and treatment?Lett us consider the investigation First, preliminary inquiries; and secondly, interview.u ut.I would remark at the that, call to a mental caso, 'especially a first call patient, should.be regarded as ann urgent one attended to.This promptness of attention necessary because advice is often .not until, the, disease -is fully developed and haa shown oetinsane 'act.'Any delay in answering a, call to a" mentalv'ase, mnight result in a traigedy of ~some'kind.The conduct of the' insane ean seldom be reckoned upon,, thetext.actie n of the person we have beev bensummoned to see may be' shomicidal, suicidal, spendthriift, or:scaudalous.3 PnRXmrIAnY INQUIRIR..The preliminary inquiries are to be made of the people who hare haid mst oppertunities of observing the patient.I