An Act (8 & 9 Vict. c. 100) for the regulation of the care and treatment of lunatics : with explanatory notes and comments, etc. etc. / edited by Forbes Winslow.

Date:
1845
Catalogue details

Licence: Public Domain Mark

Credit: An Act (8 & 9 Vict. c. 100) for the regulation of the care and treatment of lunatics : with explanatory notes and comments, etc. etc. / edited by Forbes Winslow. 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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    Condition of life, and previous occupation (if any). Previous place of abode. Religious persuasion, so far as known. Length of time insane. Whether first attack. Age (if known) on first attack. Whether subject to epilepsy. Whether suicidal or dangerous to others. Previous places of confinement (if any). I certify that to the best of my knowledge the above particulars are correctly stated. (Signed) [To be signed by the relieving officer or overseer sign- ing the order.] Dated this day of one thousand eight hundred To proprietor [or superintendent] of [describing the house or hospital by situation and name, if any]. MEDICAL CERTIFICATE. I, being a physician, or surgeon, or an apothe- cary, duly authorized to practise as such, hereby certify, that I have this day personally examined A. B., the per- son named in the statement and order, and that the said A. B. is a lunatic [or, an insane person, or an idiot, or a person of an unsound mind], and a proper person to be confined. (Signed) Name. Place of abode. Dated this day of one thousand eight hundred and