The persons signing the medical certificate must not be like relatives or partners or assistants one to the other. No one can be received as a lunatic in a hospital under an order made on the application of, or under a certificate by, a member of the managing committee of the hospital. Nor can a Commissioner or a visitor, who is a doctor, sign a certificate for the reception of a patient into a hospital or licensed house unless be is directed to visit the patient by a judicial authority under the Act, or by the Lord Chancellor, or a Secretary of State, or a committee appointed by the Judge in Lunacy. The orders and certificates may be amended under certain conditions ; they are constituted by statute as sufficient authorities for certain acts to be done, and special provision is made for them to remain in force in certain events. The manager of a lunatic institution, and any person having charge of a single patient who detains a patient after he has knowledge that the reception order has expired, will be guilty of a misdemeanour.
The Care and Treatment of lunatics is the subject of Part II. of the Act. The medical officer, or medical attendant, of an institution, after the expiration of one month after reception of a private patient, must send to the Commissioners a report of his mental and bodily condition. Mechanical means of bodily restraint cannot be applied to any lunatic unless it is necessary for purposes of surgical or medical treatment, or to prevent the lunatic from injuring himself or others. When it is applied, a medical certificate must be signed, as soon as it can be obtained, describing the mechanical means used, and stating the grounds upon which the certificate is founded. In an institution the certificate is signed by the medical officer ; in the case of a single patient, by his medical attendant. A full record of every case of such restraint must be kept from day to day, and a copy of the records and certificates must be sent to the Commissioners at the end of every quarter. As to the correspondence of lunatics it is provided that the manager of every institution, and every person having charge of a single patient, must forward unopened all letters written by any patient to the Lord Chancellor, Judge in Lunacy, Secretary of State, or to the Commissioners, or any Com missioner, or to the person who signed the reception order, or on whose petition such order was made, or to any Chancery Visitors, or to the Visiting Committee, or any member of it. He may also at his discretion forward to its address any other letter if written by a private patient. The penalty for an offence against the foregoing is X20. Any one of the Commissioners, and any one of the visitors of' a licensed house can at any time give a written order for the admission to any patient of any relation or friend, or other person who desires to see him. A manager or principal official of an institution who refuses to admit any person producing such an order is liable to a penalty of X20. An order for the examina
tion by two medical practitioners of any one howsoever detained as a lunatic may be obtained from the Commissioners by any person, vvhether a relative or friend or not, who satisfies the Conimissicnicrs that it is proper for them to grant the order. The Commissioners can order the release of the alleged lunatic if the medical certificates state that after two separate examinations (at least seven days intervening between the first and second examination) the patient, in the opinion of the medical men, may be discharged without risk or injury to hiinself or the public.
private person detained in a lunatic institution, or under care as a single patient, must be discharged if the person on whose petition the reception order was made by writing under his hand so directs. If that person is dead, or incapable by reason of insanity, absence from England, or otherwise, of signing an order for discharge, or, if' a patient having been originally classified as a pauper is afterwards classified as a private patient, the person who made the lust payment on account of patient, or the husband or wife, or if there is no hoshand or wife, or if either of the latter is incapable through insanity-, the father, or if there is no father, or he is incapable, the mother of the patient, or if there is no mother, or she is incapable, then any one of the nearest of kin of the patient may give the direction for his discharge. If there is no person qualified to direct his discharge, or no person able or willing to act, the Commissioners may order his discharge. But a patient cannot be so discharged if the medical officer or attendant certifies in writing that the person is dangerous and unfit to be at large, together with the grounds upon which his certificate is founded, unless two of the visitors of the asylum, or the Commissioners visiting the hospital or house, or the visitors of the house, or in the case of a single patient, one of the Commissioners, after the certificate has been produced, consent in writing to the patient's discharge. Any two of the Commissioners, one being a medical and the other a legal commissioner, niay, on their own initiative, visit a patient detained in any hospital or licensed house, or as a single patient, and within seven days after their visit order his discharge, if he appears to them to be detained without sufficient cause. And any three visitors of an asylum have also power to order the discharge of any person detained therein, whether he is recovered or not. And so also ha% e any two of such visitors if they have the advice in writing of the medical officer. If after two visits by two visitors to a licensed house, it appears to them that a patient is detained without sufficient cause, they may then order his discharge. Iftit one of these visitors must be a medical practitioner. l'his power of two visitors cannot be exercised, however, over a lunatic so fbund by inquisition.