Annual report of the General Board of Commissioners in Lunacy for Scotland : 42nd 1900

  • Great Britain. General Board of Commissioners in Lunacy for Scotland.
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: Annual report of the General Board of Commissioners in Lunacy for Scotland : 42nd 1900. Source: Wellcome Collection.

    254/260 (page 156)
    20 & 21 Vict. Cap. 71, Sect. 97. [Form H.] NOTICE OF DEATH. I HEREBY GIVE you Norticr, That a(4) Patient, (2) [chargeable to the Parish of ] received into this Establishment on the Day of J , died therein on the Day of 190 , at the age of ; and I further certify that (*) attended the said patient (*) and that the apparent cause of death of the said patient was as undernoted :— DURATION. Whether cause ascertained by post-mortem Years. |Months.| Days. | examination. (°) STATEMENT OF CAUSE. Primary Cause, (a) (0) Contributing RIS INT NS e e F Causes (if any) in order < (Cc) of importance, ir ORE AE PROT VPC ES CHAPEL anges Tage oe Pe (d) Signature, (3) Date, (7) Day of 190 To the (®) (1) Private or Pauper, (2) Dee words within brackets in the case of a Private Patient, and fill up in that of a Pauper. (®) Name of Medical Attendant. (4) pee sie ‘*during the illness which terminated in death,” or ‘“‘at the time of eath.” (5) Insert ‘‘ Yes” or ‘‘ No,” as case may be. (®) ‘* Superintendent of Asylum” or ‘* Governor of Poorhouse.” (7) Some day within three days of the death. (°) A copy to the Secretary of the General Board of Lunacy, one to the Party or Parish by whom the expense of the maintenance of the Lunatic is defrayed, and one to the Person on whose application the Tunatic was confined.