. 
8 
PROCEEDINGS OF THE SECTIONS. 271 
benefited by care and treatment in a special institution, or is 
dangerous to himself or others, or is liable or likely to commit an 
offence against the se There is one condition which I think may 
be added to these, and that is where the person is aconstant trouble 
or nuisance to others. Such cases are not uncommon, and the 
pe o are the sufferers from the trouble and nuisance are, 
as a rule, those in authority or occupying some prominent position. 
The following is briefly a case illustrating this :—In the excite- 
ment which followed the es uction of St. Mary’s Cathedral by 
re—you are aware how all popular excitement seizes on or S 
its echo in the brains of oni sultlind folk—a man conceived the 
insane notion that the then Governor of the Colony was the 
incendiary, and by letter-writing, haunting rare House. 
and other follies, became such a nuisance that it was necessary to 
place him in Gladesville. When this sertieiien, elena left the 
Colony I felt justified in discharging this patient, who was quiet 
and harmless, though the insane idea remained and _ probably 
remains to thi 
In the centiBiteten such facts should be stated as afford evidence 
not of insanity only, but of such insanity as renders detention, 
care, and eee advisable or necessary. This is, I think, an 
important point 
e now come to the gist, or, as a writer* on this subject fitly 
calls it, the ‘ecaariitet of. the medical certificate, what the medical 
practitioner affirms to be facts indicating insanity observed by 
himself, On 
are defective or unsatisfac to 
It seems at first sight one of the easiest possible things to fill in 
this part of the certificate, but it really requ uires some thought, 
Some practice, and some method, to state in half-a-dozen lines or 
Sentences the facts heels indicate beyond adoubt that the patient 
is insane—the symptoms of insanity which the law demands as an 
essential part of the medical certificate. 
e chief irregularities and impattornns 2 met with in medical 
certificates come under one of five headin 
Is - Opinions are stated instead . symptoms, signs, or facts. The 
patient j is described as “imbecile,” a “ confirmed lunatic,” “suffering 
6 Sia aga enti ienasimtasensmeantiionirte 
*Dr. Bucknill on Medical Certificates of Insanity. Journal of Mental 
vol. vi. 
i 
