ber the order of recent events. Questions should be asked to ascertain whether he takes any interest in political events, or knows the names of the Queen, or of any of those persons who are for the time most frequent subjects of conversation. Inquiry ought to be made as to the religious belief of the patient; as to his knowledge of the ordinary and best known tenets of religion. Besides these subjects, questions of business may be introduced, and his knowledge of the value of money, of his own affairs, and of mercantile arrangements generally, should be asked. Of course, the medical man must suit his questions to the position and education of his patient, and must judge of the answers he receives in relation to these circumstances. A coarseness that would be natural in one, would be an indication of morbid mental conditions in another, and not only must the general rank and (828) position of the examinee be borne in mind, but it is well to become familiar, if it is possible, with any mental peculiarity which may have existed before the alleged inception of the disease, and to see whether the idiosyncrasy has passed into actual disease. During the whole of the conversation we would recommend observations as to the power possessed by the individual over the concentration of consciousness, and a distinction must be drawn between the answers to those questions which necessitate a simply affirmative or negative answer and those which are likely to require considerable judgment and reflection before any satisfactory answer can be given. It is also well to note whether the patient has any control over his feelings, and a short and flat contradiction will often bring out the fact whether he does or does not possess this power. It can be easily understood that all this information cannot be elicited without much tact and ingenuity; but it must be borne in mind that much conversation upon indifferent topics is generally of very little use. Many persons who labor under any form of partial insanity can conduct a conversation upon indifferent topics for hours, and often simple allusions to the topics which are connected with the diseased belief of the individual will not immediately bring out the fact of insanity. Although we have suggested topics of conversation, the medical man must be guided very much by circumstances. Of course if a delusion exists, and if it can

be discovered by the examiner, all difficulty is at an end. But, as we have pointed out, it is of the utmost importance to determine the fact of illusion, not upon the testimony of others, but upon the facts observed by the practitioner himself. It has been recommended that when it is impossible to determine the fact of the existence of a delusion, without having recourse to the evidence of others-and this is very often the case-the source of the information should be stated, together with the information itself. Thus it might be put: "The patient tells me that he is ruined, which I am assured by his wife (or son, or lawyer, as the case may be) is an entire delusion." There is certainly a specious look about such a procedure, but it seems to be only one way of avoiding the recommendations or express enactments of the act. And it is much better if one is unable to discover sufficient indications of insanity at one interview to refuse upon that occasion to sign the certificate, and [39]to return again at another time. In such a case the necessity for incarceration cannot be very urgent, and it is certainly better to suffer, or make others suffer, an inconvenience than to do an act which may lead to gross injustice. Much difficulty will doubtless be felt in many cases where the patient in not intellectually but morally insane. In such cases, as we have seen, no delusion may be present, and the morbid propensity may manifest itself only in a series of acts, every one of which is criminal in its nature. Here the medical practitioner must be very careful, but it is right that he should sign a certificate for any individual whom he regards as markedly insane and concerning whom he would, if a crime were laid to his charge in a court of justice, make a similar assertion upon oath. But many medical men are more careful of signing a certificate which will deprive an individual of liberty, and may, in time to come, subject them to prosecution, than they are of swearing in a court of law to the sanity or insanity of an individual in whom the disease may scarcely be so marked. A careful study of the descriptions already given of the various forms of moral mania, and an inquiry into the past history of the case so as to bring into view the possible cause

Blandford on Insanity.

of the disease, will, it seems to us, in all cases enable a medical man to sign a certificate for persons laboring under this form of mental unsoundness. [330 The confession of the individual who is examined will also assist him, for they not unfrequently acknowledge their faults and deplore that sad abnormal weakness of the flesh which, as it were, compelled them to sin. The medical man must be prepared to find many cases of actual moral mania or moral imbecility in which the disease is not discernable by him in a single interview. Many moral maniacs and imbeciles, as we have seen,' are perfectly capable of reasoning accurately concerning many of these delusions, and some lunatics are adepts in concealing their delusions. Only care and an expenditure of time and patience can overcome these difficulties. With regard to the special tests which may be applied in the different kinds of moral mania described in an earlier part of this work nothing need be said in this place. The medical man must in each case adapt his examination to the supposed disease; and he must be careful not to cling too persistently to any hypothesis that he may have formed. An hypothesis is to a theory very much what a provisional committee is to the actual company of directors. It is well not to allow the one to supersede the other. It is a sign of a want of thorough education in a man if he clings to an hypothesis after it has been proved useless by the progress of discovery. It is an error many fall into. With regard to cases in which mental deterioration and decay is going on, questions which go to test the memory of recent and remote events are most important. It is well in such a case to have provided oneself previously with some accurate information with regard to some trivial event in the past life of the patient and to question him concerning it, and to compare his recollection of such circumstances with his recollection of other and more important events. Repetitions of words or sentences, questions or stories, must be noted. Forgetfulness or confusion of names, a knowledge as to his affairs, as to his children, as to places he has seen, as to people who are dead, and the strength of his volition, ought to be made subjects of inquiry.

See ante § 157 et seq.

Of course it is only in cases where the 3311dementia is still incipient or has only made a little progress that any difficulty can arise, just as it is only in the least-marked degrees of imbecility and in the partial forms of mania, that there can be any necessity for so minute an examination.

472. Examination of Letters to discover the Insanity of an Individual.-In many cases, it will be expedient to examine the letters and other writings of the patient. Many men "write themselves down" asses. They are off their guard when they are writing to some friend, and they are not under the restraint of a personal presence, or tempted to the dogmatic reticence by the questions that are put. Timid people will be bold in a letter, and insane persons will often betray their delusions in ink. A comparison between letters of a supposed lunatic during the time of the alleged insanity, and before its inception, will often prove useful.'

2473. Evidence necessary to Support Affidavit and that which must be given in Certificate.-One remark may be made upon the distinction which is drawn between the evidence necessary to support an affidavit and that which is required to be given in a certificate; and that is, that in the former a general declaration with regard to the insanity of the individual, supported by facts observed or information obtained at any number of previous interviews, or gathered from an intercourse extending over years, is all that is necessary, while all the facts that are stated in a certificate must have been observed, and all information quoted must have been obtained upon the same day upon which the certificate is signed.

474. As to the Filling up of Certificates. It is not necessary in this place to go very fully into the question of the way in which medical men ought to comply with those re

In the case of Young v. Dendy, (1 L. R., Prob. 344,) which came before the Court of Probate some years ago, the insanity of the testatrix does not seem to have been suspected by some, and was certainly not recognized by many of those who were about her until the discovery of some writings after her death, which went far to show that she must have been insane.

quirements which are made by act of Parliament with reference to the admission of insane persons into hospitals for the insane,' but one or two remarks as to the slovenly way in which many of them perform this very simple duty may be made in this place. It is a somewhat curious fact that a training which ought to make men accurate-such as a systematic study of medicine-should have the directly opposite effect. Perhaps it is, as Bacon says, writing that makes an accurate man, but one thing can be said with confidence, and that is, that medical men are most inaccurate. We were once present in a class of Medical Psychology and Mental Disease while its pupils, who were young men who had just taken their degrees, were being exercised in the filling up of certificates. The certificates when filled up were submitted to us, and we regret to say that, out of the eighteen or twenty which we examined, not one was correct. The writers had, it appeared to us, in every case, neglected to read the rubric directions, as to how it was to be filled up, with anything like rational care. The following statements, which we have procured from an asylum case-book, and which were in the certificates given under the head of "Facts (indicating Insanity observed by myself," will further illustrate, and will go far to prove, this assertion. One medical man gives as a fact indicating insanity observed by himself: "She seems to be a person of very deficient intellect, and lives alone with an old woman who is intensely deaf;" another, "laughs in an incoherent manner;" another, "answers to any questions that may be put to her, and desires to be on the open sea;" another, "that her lips are in motion as though in mental conversation;" another, "commenced laughing for a considerable time;" and still another put "an excitable aspect and oblivious manner." All these indicate a considerable amount of incoherence, at least in the medical man, and the absurd solecisms and bad grammar are too obvious to require mention. We will quote one other example that has been supplied us. "She is," says the medical man, speaking of the patient, "at this moment exclaiming vehemently about death, and the skies, and all sorts of incoherent subjects; that she is violent

See Sabben & Browne's Handbook of Law and Lunacy. London: 1872.