276 PROCEEDINGS OF THE SECTIONS. 
they were not complained of by the patient. I think no medi 
practitioner should sign a certificate in a case which he has not had 
for some time under observation, without using the clinical thermo- 
meter and listening to the chest. One of my earliest experiences 
in charge of a hospital for the insane was the reception of 
fever, which may at its onset be mistaken either for the melan- 
cholia with stupor of French, or the acute dementia of Englis 
writers, or for acute asthenic mania at a later stage. The use of the 
thermometer will go far to prevent a mistaken diagnosis, for though 
acute asthenic mania is accompanied by some increase of tempera- 
ture the rise is not nearly so marked, nor the diurnal range 80 
large as in typhoid. 
: There is a necessity for physical examination also, to ascertain 
if the patient is suffering from injury or chronic disease. Cases 
have ere now been received in institutions for the insane with 
eal examination, I may mention the necessity for ascertaining if 
The existence of physical defect or peculiarity has in some UF 
stances led to errors. A “vacant expression of countenance, 
mentioned in a certificate has been found to be due to deatness ; 
and blindness, malformation, defects in speech, and peculiarities of 
gesture may mislead unless carefully taken into consideration. 
but three certificates have lately passed through my handle: 
which the whole of the particulars or facts were in the past tense, 
and in one of them the writer actually erased the word 4s and 
made his certificate read that the patient was insane, ati nome 
by-gone period not stated. H 
n all cases, except those sent to hospital by the order of Justices, 
the currency of the medical certificate does not extend beyond wy 
days, and unless the patient is sent to hospital within ten days © 
the date thereon, fresh certificates are necessary. ould 
"In conclusion, it is well that he who signs a certificate show 
remember that he may have to defend all his * facts” ina Court 
: Law, 1k tried in th Ss ee xamination A visionof the 
Y 
