Past exam of the medicine course of the University of Oxford / 1867 / Second examination / Forensic medicine and hygiene / 2 / Solution

For an ordinary private admission in England and Wales in 1867: a prescribed written reception order and statement, together with two independent medical certificates based on separate personal examinations. Pauper admissions and certain exceptional admissions had different statutory routes. The expressions “lunatic” and “pauper” below are the historical statutory categories.

The relevant law was the Lunacy Act 1845, the Lunatic Asylums Act 1853, the Lunatics Care and Treatment Act 1853, and the Lunacy Acts Amendment Act 1862. The later Lunacy Act 1890 must not be read backwards into this examination.

For a private patient entering a licensed house or registered hospital, the 1853 care-and-treatment statute required the prescribed order and particulars, with certificates from two qualified practitioners. Each must examine the person separately within seven clear days before reception; partners and assistants could not certify together. Each certificate must distinguish personally observed facts indicating the alleged mental disorder from facts reported by others: hearsay alone was insufficient. The statute also excluded specified relationships and interests connecting certifiers with the institution or order-maker. The exceptional single-certificate route required the special circumstances to be recorded and two further independent certificates within three clear days of reception.^[ref]

The 1862 amendment added that the private order-maker must have seen the person within the preceding month and record when and where. The order ceased to authorize reception after one calendar month. Additional disqualifications concerned financial interests and institutional medical attendants. Where possible the admission order should name and give the address of a relation. The principal admission documents for private patients had to reach the Commissioners within one clear day; the subsequent medical statement remained a separate return. A person already found subject to the relevant jurisdiction by formal inquisition had a distinct route through the appointed committee's order and the court documentation.^[ref]

For a county or borough asylum, the Lunatic Asylums Act 1853 supplied the corresponding private-patient procedure. For a pauper patient, the ordinary route involved official inquiry and a reception order, normally by a justice, supported by one medical certificate and the prescribed particulars. The statute also provided a route involving an officiating clergyman with a relieving officer or overseer, subject to its conditions. The medical examination must again be within seven clear days before reception. Thus “two doctors and a relative's request” is not a complete account of every admission.^[ref]

The practical sequence is to ascertain the applicable legal category, arrange the required examinations and order, check qualifications, independence, facts, dates and signatures, and deliver the documents to the authorized institution before reception. An unsupported allegation by a relative or a bare medical assertion supplies none of these safeguards. This is an account of Historical English asylum admission, not a statement of present admission law.