US Legislation on Asylum Confinement

In 1910 the public charities expert John Koren was appointed by the US National Committee for Mental Hygiene to collect all laws relating to the commitment of the insane operating in the 49 states of the federation. It was not the first attempt to bring all American legislation on lunacy under a single heading. George Harrison, for instance, singlehandedly advanced such a project in 1884 and privately published his work. Similarly, the New York Chairman of Public Charities Stephen Smith analyzed the provisions operating in each state and proposed –without success– a unification of the laws concerned with insanity in 1892.

After extensive research, Koren published his report 1912. Based on Koren’s research, the following table includes excerpts from the provisions regulating civil confinement in the 49 states. Besides providing the original statutes, it assigns each state according to the scheme advanced in the previous post. It divides all laws into four categories, namely No Medical Judgement (1 state), Joint Medical and Lay Judgement (12 states), Priority to 1 Physician (14 states), Priority to 2 Physicians (22 states).

Category State/Territory Original Text Authority
No Medical Judgement Kentucky Inquests to determine whether a person is of unsound mind (idiot, lunatic, non compos) must be held by the circuit court of the county. […] The case must be heard before a jury. Statutes of Kentucky 1909, c. 4247
Joint Medical and Lay Judgement Alabama When informed by the superintendent that the person can be received as a patient, the judge of probate must call witnesses, at least one of whom must be a physician, and fully investigate the facts of the case, either with or without a jury, and either with or without the presence in the court of the person in question. If the judge or the jury believe the person is sufficiently defective mentally to be sent to a hospital for insane persons, the judge must make two copies of the certificate of the mental disqualifications, without which no person may be admitted, one of which is to be filed in his office, and the other to be sent with the patient to the hospital. Code of Alabama, 1907, c. 859
Arizona The probate judge of any county, upon a sworn application that a person by reason of insanity is dangerous if at large, must cause the person to be brought before him for examination and summon two or more witnesses acquainted with the accused at the time of the alleged insanity. He must also call in two graduates of medicine and reputable practitioners to be present at the hearing, and after a personal examination of the accused to make a written statement under oath in regard to his mental condition, whether it is unsafe to let him go at large and whether his insanity is likely to prove permanent or only temporary. If the proofs satisfy the judge that the person is insane and can not safely be allowed at large, he must direct the confinement of such person in the hospital for the insane until sufficiently restored to reason. Revised Statutes of Arizona, 1901, c. 2768
Florida A petition signed by five reputable citizens, not more than one of whom may be a relative of the person, stating their belief that he is insane, and asking that a legal examination be made, may be presented to the county judge or judge of the circuit court having jurisdiction. The county judge or judge of the circuit court to whom the petition is submitted must without unnecessary delay appoint as an examining committee one intelligent citizen, who is not a petitioner in the case, and two practicing physicians of good professional standing who are graduates of a school of medicine recognized by the American Medical Association, when such physicians reside in the county. This committee must secure the presence of the supposed insane person, and make a thorough examination to ascertain his mental and physical condition, and if considered insane, whether the insanity is acute or chronic, its apparent cause, the hallucination, if any, and the age and propensities of the subject, also whether he is indigent or possessing available means for his support. Constitution of the State of Florida, 1907, Art. 1200
Georgia A pay patient requires a certificate of three a certificate of three reputable practicing physicians, well acquainted with his condition, or from one such physician and two respectable citizens. A pay patient, not a resident of the state, may not be admitted unless producing an authentic record of a conviction by a competent court of a malady which, according to the law of the state, is a ground of admission, or a certificate of physicians endorsed by the judge having jurisdiction.

The certificate of the ordinary of the county where an of insane negro resides, of his condition, mental and pecuniary, is sufficient to grant his admission to the hospital.

Code of Georgia, 1911, c. 1601
Indiana Proceedings for committing an alleged insane person to a general state asylum for the insane are by a sworn statement regarding his insanity by a citizen of the county filed with a justice of the peace and upon an examination and a hearing held by this justice and two reputable practicing physicians of the county selected by him, or by the circuit or superior court. At this hearing the justice may examine witnesses against and in behalf of the person alleged to be insane, may summon medical examiners, and must obtain a certificate of the medical attendant of the alleged insane person giving the medical history of the case. Laws of Indiana 1909, c. 3101
Kansas Citizens file a sworn statement with the probate judge of the county court that the person is insane and unsafe to be at large. The statement must be accompanied by the names of two witnesses. If the person alleged to be insane has not been examined by a physician, the judge may appoint a qualified physician of the county to make an examination.

When no jury is demanded or a trial by jury is not expedient, the probate judge must appoint a commission of two qualified physicians in regular practice to make a personal examination of the patient and file with the probate court a sworn report of their findings. The commission has power to administer oaths and take sworn testimony. Inquests in lunacy may be in open court, or in chambers, or at the house of the person alleged to be insane; the presence of the accused is indispensable. A jury of four persons, one of whom must be a physician who has been in regular practice for three years and of good standing, must be impaneled when a case is tried by jury.

Laws of Kansas, 1911 c. 8464
Louisiana The judge must order the person to be brought before him, and summon two licensed and reputable physicians, one of whom must be the coroner of the parish, and the other the physician of the suspected person, if he has any, neither of whom may be related by affinity or consanguinity to him or have any interest in his estate. The judge and the two physicians constitute a commission to inquire whether the person is insane and a suitable ‘subject for a hospital for the care and treatment of insane persons and for that purpose the judge must summon witnesses who know the person suspected of insanity. The physicians in the presence of the judge must by personal examination satisfy themselves and the judge as to the mental condition of the suspected person. If the two physicians do not agree, the judge determines the issue. Laws of Louisiana 1910, c. 420.
Minnesota Whenever the probate judge or in his absence the court commissioner of any county receives duly verified information that there is an insane person in his county needing care and treatment, he must order the person to be brought before him for examination, and appoint two examiners in lunacy who with a judge or court commissioner constitute a jury to examine the insane person. The county attorney must be notified of the examination’ and appear on his behalf to take such action as may be necessary to protect his rights. Upon the request of the county attorney, the judge or court commissioner must issue subpoenas for the attendance of witnesses for the alleged insane person. If the examiners find the person to be insane and a fit subject for hospital treatment, they must certify to the fact within twenty-four hours after the examination, whereupon the judge or court commissioners must issue a duplicate warrant committing the person to the superintendent of the proper state hospital, or to the superintendent of any private licensed institution for the care of the insane. If the jury finds the person to be sane or disagrees, it must certify to the fact, and the person must thereupon be discharged.

At each city or village where a state hospital for the insane is located a state hospital commission composed of three reputable persons, at least one of whom is a duly qualified physician, must be appointed by the judge or judges of the district court to hold office for two years. The commission has power to examine alleged insane persons and determine whether they are insane.

Supplement Revised Laws of Minnesota, 1909, c. 3856-1, 1916-6
Missouri The county clerk must convene the county court forthwith for the purpose of passing upon the sanity or insanity of the person apprehended. At the hearing the court must have witnesses examined before themselves, or a jury, if one be ordered for the purpose. At least one of the witnesses examined must be a respectable physician.

If the court, or the jury, is satisfied of the truth of the facts of the statement, it must enter an order to the effect that the person found insane is a fit subject to be sent to the state hospital, and require the medical witness to make out a detailed history of the case in the prescribed form.

Laws of Missouri 1911, c. 1418-1421
Montana Whenever it appears to the satisfaction of the magistrate of the county that any person within the county is so far disordered in his mind as to endanger health, person or property, he must have the person arrested and taken before any district judge in the county for examination, or, in his absence, before the chairman of the board of county commissioners. The judge or chairman of the board must issue subpoenas to two or more witnesses best acquainted with the insane person and at least two graduates of medicine, to attend and testify at the examination.

If the physicians believe the person to be dangerously insane, they must make a certificate to this effect, describe the symptoms, etc., and give other facts, in a form prescribed by the board of commissioners for the insane. If the judge, or the chairman of the board of county commissioners, after such examination and certificate are made, believes the person to be dangerously insane, he must order him to be confined in the insane asylum, and a copy of such order must be filed with and recorded by the clerk of the district court of the county.

Revised Codes of Montana 1907, c. 1134-114
West Virginia Any justice who suspects any person in his county to be a lunatic must issue his warrant ordering such person to be brought before him for examination, and for that purpose must summon a physician and any other witnesses. […] The interrogatories to the witnesses and the answers must be in writing, and, together with a written statement by the justice to the fact of insanity, must be transmitted with the order of commitment. Code of Virginia 1906, c. 2644-2646
Wyoming The determination of the insanity or incompetency of any person is by a jury of six men and is conducted as a civil action. If the jury returns a verdict that the person tried is insane, the county physician, or some reputable physician appointed by the court must furnish a lunacy statement in prescribed form, containing answers to the questions prescribed and must return it to the clerk of the district court, within three days after the finding of the jury in such proceedings.

The committing judge must in addition to the order of commitment and the statement in lunacy, issue a certificate showing the name, age, sex, nativity, and occupation of the person committed and his place of residence. The clerk of the court must send a certified copy of the verdict and the physician’s lunacy statement, together with the commitment warrant to the superintendent of the hospital at the time of commitment.

Compiled Statutes of Wyoming 1910, c. 453, 457
Priority to the Judgement of 1 Physician Colorado The county court must have the patient taken into custody. If a sheriff or constable finds such an insane person at large in his county, he must apprehend him without an order of court. The insane person so arrested is then taken before the county court, and if he so elect, an inquest must be held without delay, and until its determination, he must be confined in a hospital or in some suitable place to be designated by the court. […] No insane person may be confined in any city or county unless he is violent and his absolute safety demands such confinement, and then only upon an order from the county court, under the penalty of a fine of $10 to $100 or imprisonment for 10 to 90 days, or both.

A physician testifying to the insanity of any person for the purpose of securing his commitment to custody must be of reputable character, a graduate of some incorporated medical college, a permanent resident of the state, in the actual practice of his profession, and not connected with any institution for the insane. The possession of such qualifications must be certified by the judge of a court of record, and his certificate shall constitute such physician an examiner in lunacy.

Revised Statutes of Colorado, 1908, c. 4128, c. 4139
Idaho The alleged insane person to be arrested and taken before any judge for examination. Two or more witnesses, best acquainted with such insane person and at least one graduate of medicine must testify at the examination. If the physician after hearing the testimony and making the examination believes such person to be dangerously insane, he must make a certificate in the form prescribed by the medical superintendent of the asylum, showing that such person is so far disordered in his mind as to endanger health, person or property; the premonitory symptoms, apparent cause or class of insanity, the duration and condition of the disease, etc. Revised codes of Idaho, 1909, c. 775, 776
Illinois Any reputable citizen of the county in which a person supposed to be insane resides or is found may file with the clerk of the county court a sworn statement that the person named is insane and requires restraint or commitment to some hospital for the insane. The statement must be accompanied by the names of the witnesses (one of whom at least must be a physician having personal knowledge of the case). When the person alleged to be insane has not been examined by a physician, the judge may appoint a qualified physician of the county to make such examination. The hearing of the case may take place with or without the presence of the person. Revised Statutes of Illinois, 1908, c. 85
Iowa Applications, directed to the commissioners of insanity, for admission to the hospital must be made in the form of an information, verified by affidavit, alleging that the person in whose behalf the application is made is believed by the informant to be insane, a fit subject for custody and treatment in the hospital, and that he is found in the county. […]

The commissioners must appoint some regular practicing physician of the county to make a personal examination of the person alleged to be insane. The examining physician must endeavor to obtain from the relatives of the person, or from others who know the facts, answers to prescribed interrogatories, the answers to be attached to his certificate.

Code of Iowa 1897, c. 2264, 2266
Nebraska Application for admission to a hospital must be made to the county commission of insanity in writing, verified by affidavit, alleging that the person applied for is believed to be insane and a fit subject for custody and treatment in a hospital.

The commissioners must at once take steps to investigate the grounds of the information. They may require the alleged insane person to be brought before them, and the examination had in his presence, providing for his custody until their investigation is concluded. They may dispense with his presence if it would probably be injurious to him or attended with no advantages. They must hear testimony for and against the application.

Any citizen of the county or any relative of the person may resist the application, and employ counsel if they choose. The commissioners must in all cases appoint some regular practicing physician of the county to make a personal examination of the person alleged to be insane. The physician may or may not be of their own number, and the one appointed must certify whether he finds the person in question insane or not. He must endeavor to obtain from the relatives of the person in question, or from others who know the facts, correct answers so far as may be to the interrogatories prescribed by law, which with the answers to them must be attached to his certificate.

Statutes of Nebraska 1911, c. 10069
Nevada The judge of the district court in each judicial district in the state, upon the sworn application that any person by reason of insanity is unsafe to be at large, or is suffering from mental derangement, must cause such person to be brought before him, and cite one or more licensed practicing physicians to examine the person alleged to be insane. If the physicians certify upon oath that the charge is correct, and if the judge is satisfied that the person is unsafe to be at large by reason of insanity, incompetent to provide for his proper care and support, has no property applicable for such purpose, and no kindred in the degree of husband or wife, father or mother, children, brother or sister living within this state of sufficient ability to provide care and support, he must commit him to the hospital, and transmit to the superintendent a copy of the complaint, commitment, and physicians’ certificate, which must be in the form prescribed by the board of commissioners. Compiled Laws of Nevada, 1900 c. 1469
New Mexico Whenever it appears, by affidavit, to the satisfaction of a judge of the peace of any county, that a person within the county is so far disordered in his mind as to endanger his health, person or property, he must issue a warrant directing the person to be taken before any judge of the district court within the proper district for examination. The judge of the district court must subpoena two or more witnesses, best acquainted with said person, to appear and testify before him at the examination. A subpoena must also issue for at least one graduate of medicine, requiring him to attend the examination. If the physician certifies that the person is insane and that it would be dangerous for him to be at large in the community, and the court is satisfied of the same, he must order the person to be committed to the state hospital. If the person is indigent, the judge must so certify to the board of directors of the hospital. Compiled Laws of New Mexico 1897, c. 3619
North Carolina Some respectable citizen, residing in the county of the alleged insane person, must file an affidavit with a clerk of the superior court of the county that the person in question is a fit subject for admission to a state hospital. The clerk may then have the alleged insane person brought before him or go to his residence, and examine into the condition of his mind, with the assistance of the county physician and the advice of other reputable physicians. He must take the testimony of at least one recognized physician, resident of the state, and if possible, of a member of his family or friend. If the clerk decides that such person is insane, and some friend will not give bond guaranteeing his good behavior and to keep and support him until the cause for confinement ceases, the clerk must order his removal to the proper hospital, and submit to the board of directors the examination of the witnesses. Pell’s Revisal of the Laws of North Carolina 1908, c. 4575-4582
North Dakota Applications for admission to the hospital must be made in writing, verified by affidavit, alleging that the person in whose behalf the application is made is believed to be insane and a fit subject for custody and treatment in the hospital for the insane. The commissioners must at once investigate the grounds for the application and may require the person for whom admission is sought to be brought before them for examination. Any citizen of the county or any relative of the person alleged to be insane may appear and resist the application, and the parties may appear by counsel. The commissioners, whether they decide to dispense with the presence of the person alleged to be insane or not, must appoint some regular practicing physician of the county, who may be of their own number, to make a personal examination of him. The physician appointed must certify that he has made a careful personal examination, and that he finds the person in question insane or not insane. In connection with the examination, the physician must endeavor to obtain from the relatives of the person in question, or from others, correct answers as far as may be to the interrogatories required by the law. If the commissioners find the person insane and a proper subject for treatment at the hospital, they must authorize the superintendent to receive him. Laws of North Dakota 1911, c. 1893
Oklahoma Application for admission to a hospital must be made in writing in the nature of an information verified by affidavit, alleging that the person on whose behalf the application is made is believed to be insane and a fit subject for custody and treatment in a hospital ; that he is found in the county and has a legal settlement therein; and if such settlement is not in the county, where it is. The commissioners must at once investigate the grounds of the informant, and may require that the person for whom admission is sought be brought before them and examined.

The commissioners must appoint some regular practicing physician of the county to make a personal examination of the person alleged to be insane. The physician must certify that he has made a careful personal examination, and that he finds the person in question insane, or not insane. He must endeavor to obtain from the relatives of the person in question, or from others who know the facts, correct answers to the prescribed interrogations, which with the answers must be attached to his certificate. On the return of the physician’s certificate, the commissioners must find whether the person alleged to be insane is insane.

Compiled Laws of Oklahoma 1909, c. 3701-3707
Oregon The county judge of any county in the state, upon application of any citizen in writing stating that any person or persons by reason of insanity or idiocy is suffering from neglect, or is unsafe to be at large, or is suffering from mental derangement, must cause such person to be brought before him for a hearing, summoning at the same time one or more competent physicians to examine the person alleged to be insane or idiotic. If the physician or physicians, after careful examination, certify upon oath that the person is insane or idiotic, the judge upon approving their findings, must provide for the safe-keeping of the person and cause him to be conveyed to the insane asylum. Lord’s Oregon Laws 1910, c. 4435, 4436
South Dakota The commissioners must appoint some regular practicing physician of the county to examine the person alleged to be insane, and to report to the commissioners. The physician may or may not be of their own number. The physician must endeavor to obtain from the relatives of the person in question or from others who know the facts correct answers, so far as may be, to the prescribed interrogatories, which with answers must be attached to his certificate. On the return of the physician’s certificate, the commissioners must find whether the person is insane and a fit subject for treatment and custody in the hospital, and where his legal settlement is. If they find him insane and a fit subject for treatment and custody in the hospital, they must issue their warrant authorizing the superintendent of the hospital to receive him as a patient. Laws of South Dakota, 1911, c. 170
Tennessee In the case of non-paying patients, some reputable citizen of the county to which the patient belongs must file a written statement in prescribed form of the case with a justice of the peace of the county. The justice then issues his subpoenas for the persons named as witnesses, and such other persons as he may think proper, requiring them to appear before him at a specified time, to testify concerning the facts set forth in the statement. If the justice is satisfied of the truth of the allegations in the statement, he must require the medical witnesses to make out a certificate according to the form prescribed by law, certify to his inquest and transmit to the clerk of the county court a certificate of the proceedings. The clerk must transmit a copy of the proceedings to the superintendent of the hospital accompanied with an application for the admission of the patient named. The superintendent must immediately advise the clerk whether and when the patient can be received.

Paying patients may be admitted to a state hospital upon payment in advance of charges for a specified period, furnishing a bond for future payment, and upon the presentation of a medical certificate of insanity in prescribed form, signed by at least one reputable physician.

Acts of Tennessee 1909, c. 2617
Texas Before any person can be received at a hospital as a patient, the parent or legal guardian of such person or some near relative or other person interested must present a written request to the superintendent, giving such particulars as may be required. The request must be under oath and accompanied by an affidavit of the examining physician showing that he has made a careful examination of the patient, and thoroughly believes him to be insane, and by a certificate from the county judge of the county where the alleged insane person resides. A complete history of the patient must be forwarded to the medical superintendent with the application for admission. Laws of Texas 1911, c. 113, 128
Priority to the Judgement of 2 Physicians Arkansas The county or probate judge must appoint a time as soon as practicable to hear the testimony of witnesses, and must cause the insane person to be examined separately by two reputable, competent and disinterested physicians, who shall severally present to the county judge a sworn statement of the result of their examinations. Digest of the Statutes of Arkansas, 1904, c. 4195
California The superior judge of each county, or city and county, may grant certificates to medical examiners in accordance with the form prescribed by the commission, showing that the persons named are reputable physicians and graduates of incorporated medical colleges, and have been in actual practice at least five years. There must at all times be at least two such medical examiners in each county. […] At least two medical examiners must hear the testimony of all witnesses, make a personal examination of the alleged insane person, and testify before the judge as to the result of the examination, and to other pertinent facts. The judge must examine any other proper witness who has any knowledge of the mental or financial condition of the alleged insane person or financial condition of the persons liable for his maintenance. The alleged insane person must be present at the hearing. Laws of California, 1911, c. 227, c. 2167-2170
Connecticut The court must require, in addition to any oral testimony, the sworn certificates of at least two reputable physicians, who are graduates of legally organized medical institutions and have been practitioners of medicine at least three years within the state, and are not connected with any asylum nor related to the complainant, nor to the person alleged to be insane. One of the physicians is to be selected by the court. The certificate of the physicians must state that they have personally examined him within ten days of the hearing, and that, in their opinion, he is insane and a fit subject for confinement in a hospital. Public Acts of Connecticut, 1903, c. 2739
Delaware A certificate must be filed made and signed by at least two physicians residents of this state, who have been actively engaged in practice in the same state and county as that in which alleged insane person resides. The certificate must state that the physicians have separately examined the person, that they believe that his disease requires hospital care and treatment; and that they are in no way related by blood to or connected by marriage with him, nor in any way connected with the hospital.

[In the case of an indigent insane person] relatives or friends apply to the chancellor either personally or by petition presenting the certificate of two practicing physicians giving the county wherein the person resides, one of whom must be the regular physician of the almshouse of the county, stating the facts of his insanity, and the necessity of better medical treatment of such case than can be afforded in the almshouse, the chancellor, if satisfied with the proofs of insanity offered, must refer the application to the trustees of the poor of the county for information.

Revised Codes of Delaware amended in 1893, c. 49, Laws of Delaware 1909 c. 644.
District of Columbia An insane person within the District may be apprehended and restrained without warrant by any member of the metropolitan police or any other official in the District authorized to make arrests. […] The superintendent of the metropolitan police is authorized to order the apprehension and detention without warrant of any indigent person alleged to be insane or who has homicidal or dangerous tendencies and found elsewhere than in public places, upon the affidavits of two or more responsible residents, which must state that they believe the person to be insane. […] Before the apprehension is ordered, the superintendent of the metropolitan police must require the certificate of at least two physicians who shall certify that they have examined the person alleged to be insane and that he should not be allowed to remain at liberty, and that he is a fit subject for treatment. The commissioners of the District of Columbia are authorized to place in the government hospital for the insane for a period not exceeding thirty days, Code of Law of the District of Columbia 1910, c. 2, 3, 4.
Maine The municipal officers of towns constitute a board of examiners, and on complaint in writing of any blood-relative, husband or wife of an alleged insane person, or of any justice of the peace, they must immediately inquire into his condition, appoint a time and place for a hearing, and notify the person alleged to be insane.

To establish the fact of insanity, the evidence of at least two reputable physicians given by them under oath before the board of examiners is required, together with a certificate signed by the physicians and filed with the board, the evidence and certificate to be based upon due inquiry and personal examination of the person in question,

Laws of Maine 1909, c. 144 s. 15, 16, 17
Maryland The municipal officers of towns constitute a board of examiners, and on complaint in writing of any blood-relative, husband or wife of an alleged insane person, or of any justice of the peace, they must immediately inquire into his condition, appoint a time and place for a hearing, and notify the person alleged to be insane.

No person may be committed or confined in any institution for the insane except upon written certificate of two qualified physicians, made within one week after examination of the alleged insane person, stating his insanity and giving the reason for their opinion. It is unlawful for any physician to certify to the insanity of any person for the purpose of committing him to an asylum or institution for the insane, with which the physician may be in any manner connected or interested in. The medical superintendent or chief officer of any institution for the insane, except almshouses, may receive voluntary patients who make application in writing, provided that the expense be borne by the person applying or by his relatives or friends. No voluntary patient may be detained for more than three days after having given notice of desire to leave the institution unless he in the meantime has been legally committed.

Laws of Maryland of 1886 as amended by the Act of 1910, s. 31, 32
Massachusetts Judges of probate or a justice of a court within his county can commit lunatics. Commitment may not be made unless there has been filed with the judge a certificate of the insanity of the alleged insane person y at least two physicians, nor without an order signed by the proper judge, stating that he finds the person committed to be insane, and either that he has been an inhabitant of the commonwealth for six months immediately preceding the finding, or that provision satisfactory to the state board of insanity has been made for his maintenance, or that by reason of insanity he would be dangerous if at large. The order of commitment authorizes the custody of the insane person either at the hospital to which he is first committed, or at some other hospital to which he may be transferred. The judge must see and examine the alleged insane person if he deems it advisable to do so, and must certify to the residence of the person at the time of his commitment. The judge may call in a third physician when he deems it advisable.

The physician must have examined the alleged insane person within five days of the certificate. A copy of the certificate, attested by the judge, must be transmitted to the superintendent of the hospital to which the insane person is committed, who in turn transmits copies to the state board of insanity. […] A statement containing facts in the form prescribed by the state board must be filed with the application and a copy sent to the superintendent of the institution.

Acts of Massachusetts, Chapter 504, 1909, s. 29-33
Michigan Petition of a probate court of the county for the admission to an asylum for the care of the insane. The petition must contain a statement of the facts upon which the allegation of insanity is based. […] The court must fix a day for a hearing and appoint two reputable physicians to make the required examination of the alleged insane person, whose certificate must be filed with the court.

The physicians must make a personal examination of the alleged insane person enabling them to form an opinion as to his sanity or insanity, and no certificate of insanity may be made except after personal examination. Certificates of insanity must contain the facts and circumstances upon which the opinion of the physicians is based, and show that the condition of the person examined requires his care and treatment in an asylum for the insane. A copy of the physician’s certificate together with a copy of the application for commitment of the patient must accompany the order of commitment.

Public Acts of Michigan 1911, c. 25
Mississippi The clerk of the chancery court must, on the application in writing and under oath of any citizen, direct the sheriff by a writ of lunacy to summon the alleged insane person to contest the application, and six freeholders to sit at the hearing. The result of the inquisition must be returned to the clerk. The jury must be charged by him to make due inquest (the particulars being prescribed by law). If the person is adjudged a lunatic or insane by the jury, or a majority of its members, and the jury finds that he should be confined, the clerk must direct the sheriff to arrest him and place him in one of the insane hospitals if there is a vacancy, and, if not, to confine him in the county jail pending such vacancy.

On application for admission to an insane hospital made on behalf of an insane person who is a resident of this state, the superintendent and trustees may admit him to the same. Before his admission, the person making the application must present to the superintendent a sworn certificate from two licensed, practicing physicians, and one respectable citizen who is personally acquainted with the alleged insane person, all of whom must be residents of the same county in which he resides. Upon receipt of such application and certificate, the superintendent must forward to the physicians blank forms to be filled out giving the history of the patient, form of insanity, and such other information as may be required. The superintendent must obtain all the available facts relative to the lunacy of each patient admitted on an adjudication of insanity

Code of Mississippi 1906, c. 3219, 3220
New Hampshire No person may be committed to the state hospital, except by an order of the court or the judge of probate, without the certificate of two reliable physicians, given after a personal examination made within one week of the committal.

The physicians must immediately report the result to the court, who may upon their report order the person to be committed to the state hospital when there is a sufficient reason for so doing. The certificate of the physicians must be accompanied by a certificate of the judge of the supreme court or court of probate, mayor or one of the selectmen.

Session Laws of New Hampshire 1907, c. 14, 15
New Jersey No one may be committed in any institution except upon filing with the medical director of the institution an application in writing by the person interested in his admission. The application must state the age, place of nativity, name, place of residence and occupation of the person to be committed, etc., and be accompanied by the sworn certificates of two physicians.

No person may be held in confinement for more than fifteen days unless the person applying within that time presents to the justice of the supreme court presiding in the courts of the county in which the person so confined resides, or a judge of the circuit court, or of the court of common pleas of the county, the application with the certificates. The judge may make inquiry and take proofs as to the insanity of the person so confined, and in his discretion call a jury. The inquiry must be concluded if possible within fifteen days after the presentation of the application.

A physician certifying to the insanity of any person for the purpose of securing his commitment as insane must be of reputable character, a graduate of some incorporated med- ical college, a permanent resident of the state, who has been in the actual practice of his profession for at least five years. […] No certificate of insanity may be made except after a personal examination of the person alleged to be insane held not more than six days prior to his confinement, and according to forms approved by the managers of the state hospitals for the insane. The medical certificates must contain a thorough description and identification of the person sought to be confined, and all the facts obtainable in regard to his malady.

Laws of New Jersey 1912 c. 126-131
New York A person alleged to be insane, who is not confined upon a criminal charge, may be committed to an institution for the insane by an order made by a judge of a court of record of the city or county, or a justice of the supreme court of the judicial district, in which he resides, upon a certificate by two qualified medical examiners in lunacy, accompanied by a verified petition, or upon such certificate and petition after a hearing to determine the question. The hospital commission furnishes blanks for such certificates and petitions. An insane person may be committed only to a state hospital, a duly licensed institution for the insane or the hospitals for the criminal insane, or to the care and custody of relatives or a committee.

The certificate of lunacy must be made out by two reputable physicians graduates of an incorporated medical college, who have been in actual practice at least three years, and have filed with the commission a copy of the certificate of a judge of a court of record, showing such qualifications in accordance with the forms prescribed by the commission. The physicians must jointly make a final examination within ten days before the order is granted. The certificate must contain the facts and circumstances upon which the judgment of the physicians is based and state that the condition of the person requires care and treatment in an institution for the insane. Neither of the physicians may be a relative of the person or have any interest in the institution to which it is proposed to commit him.

If an insane person needs immediate care and treatment, or is dangerously insane, he must at once be received by a state or licensed institution authorized by law to care for the insane on a certificate of lunacy executed by two medical examiners in lunacy after examination upon the presentation of a proper petition, but may not be retained for a period exceeding ten days.

Laws of New York 1912, c. 80, 81
Ohio Within five days after the affidavit is filed, the probate judge must issue a warrant for the apprehension of the alleged insane person, fix a day for the hearing, and summon witnesses, two of whom must be reputable physicians. If any person resists the affidavit, the judge must subpoena the persons demanded on behalf of the person alleged to be insane.

After hearing all the testimony and being satisfied that the person is insane, the judge must cause a certificate to be made by two medical witnesses of the person’s insanity. The medical witnesses must have at least five years’ experience in the practice of medicine and not be related by blood or marriage to the person alleged to be insane or to the person making the application. The medical certificate must be in the form prescribed by the state board of charities with the advice of the superintendents of the several hospitals. Upon receiving the medical certificate, the probate judge must at once apply to the superintendent of the hospital situated in the district in which the patient resides, transmitting at the same time all the papers in the case.

Laws of Ohio, 1911, c. 1953-1958
Pennsylvania On statement in writing to a judge in the common pleas or quarter sessions of any respectable person that a person is insane, and that the welfare of himself or of others requires his restraint, the court must immediately appoint a commission to inquire into the facts of the case. This commission must be composed of three persons, one of whom at least shall be a physician and another a lawyer. They hear evidence and the statements of the party complained of, or of his counsel, and if, in their opinion, it is a suitable case for confinement, the judge must issue his warrant for such disposition of the insane person as will secure the object of the measure.

No person may be received as a patient in any institution for the insane without a certificate signed by at least two resident physicians who have been in actual practice for at least five years, both of whom must certify that they have examined separately the person alleged to be insane, and that he requires care and treatment in a hospital or other establishment for the insane. The certificate, duly attested under oath, before a judge of the county certifying to the standing and good repute of the signers, must have been made within a week of the examination of the patient, and within two weeks of the time of the admission of the patient. No person alleged to be insane may be received into any house for treatment or detention unless at the time of his reception the person or persons at whose instance commitment is made states in writing that in their belief the detention is necessary and for the benefit of the insane person. The law prescribes in detail the facts concerning insane persons which must be made known at the time of admission to the superintendent who receives him.

Laws of Pennsylvania 1911, c. 124, 108
Rhode Island Upon the written application of the parent, guardian, relative or friend of an insane person, accompanied by the certificates of two practicing physicians registered in the state, that such person is insane, the board of state charities and correction is authorized to receive him for care and treatment upon such terms as it may fix.

Upon sworn complaint to any justice or clerk of a district court that a person within the county is so insane as to be dangerous to the peace and safety of the public, the justice or clerk must issue a warrant for the person and have him brought before the district court for examination. When the complaint is accompanied by a certificate signed by two practicing physicians in the state declaring that the alleged insane person can not without serious consequences be examined in open court, district courts are empowered to hold examinations at times and places most conductive to the health and comfort of the person examined.

Any physician who unlawfully commits to any lunatic asylum a person who is not insane is liable to a fine not exceeding $500 or imprisonment not exceeding five days.

Public Laws of Rhode Island 1909-1910, c. 48, 96
South Carolina Application by a relative, friend or citizen for commitment of an insane person to the hospital must be made to the judge of probate of the county in which the alleged insane person resides. The judge may investigate the case by examining witnesses or not as he sees fit, and if he is reasonably convinced that the application is a just one, he must transmit answers to the list of interrogatories prepared by the regents, and forward them to the superintendent of the hospital with an application for admission. If necessary the superintendent may refer the application to the board of regents before final answer.

When informed that the person can be received, on what terms, and under what class, the judge of probate must call two physicians to certify to the insanity of the person. The physicians must be registered according to the law of the state and may not be related to the patient. They must certify that he is not an epileptic, a lunatic incurable at home, and that he is violent and dangerous. If the judge of probate believes that satisfactory evidence has been offered of the person’s insanity, he must make certificates as required by the board of regents, and send the insane patient to the hospital.

Code of Laws of South Carolina 1902, c. 2251-2252
Utah The district judge of the county may examine the informant under oath and require the person for whom admission is sought to be brought before him. If satisfied that there is reasonable cause, a hearing must be had, and the district attorney notified. Any citizen of the county or any relative or a friend of the person for whom application is made may resist the application, and may appear by counsel. The district attorney must represent the state in such examination. The judge must summon two practicing physicians before whom the examination is to be conducted. The physicians must certify under oath whether or not the person is insane, whether the case is of recent or curable character. They must also obtain from others correct answers to the interrogatories of the certificate as prescribed by law. If the judge upon the conclusion of his investigation finds the person insane, and one who ought to receive care and treatment at the hospital, he must order his commitment. Laws of 1909, c. 2168, 2173
Vermont Admission to a hospital for the insane as a patient or inmate is upon a certificate of his insanity made by two legally qualified physicians, residents of this state. The physicians must not be members of the same firm; officers of a hospital for the insane in this state, nor members of the board of supervisors of the insane. The physicians must make oath to the certificate before a magistrate, who must append his jurat, and certify that said physicians are of unquestionable integrity and skill. The certificate must not be made more than ten days before the admission of the insane person to the hospital for the insane, unless a longer time is required to dispose of an appeal taken from the decision of the physicians. The physicians are required to examine the supposed insane person not more than five days previous to making the certificate; and a physician who signs a certificate without making a previous examination shall, if the person is admitted to a hospital for the insane upon the certificate, be imprisoned not more than two years or fined not more than $1,000, or both. Public Acts of Vermont 1908, c. 3753-3756
Virginia Any county or corporation judge, or any justice of the peace, who suspects any person in his county or corporation to be insane, or upon the written complaint or information of any respectable citizen, must order the presence of such person, and summon two licensed and reputable physicians (one of whom must, when practicable, be the physician of the suspected person, but neither may in any manner be related to him or have an interest in his estate). The judge or justice and the two physicians constitute a commission to inquire whether the person is insane and a suitable subject for treatment in a hospital for the insane, and for that purpose must summon witnesses. The physicians must, in the presence of the judge or justice (if practicable), by personal examination and by inquiry satisfy themselves and the judge or the justice as to the mental condition of the person examined. If the two physicians do not agree a third is to be summoned. The report of the commission must consist of a statement with questions and answers prescribed by the law, and of any further information bearing on the insanity of the person being examined. The record of proceedings together with the warrant of commitment must be made in duplicate, one copy to be delivered to the sheriff or sergeant of the county or city, and the other to be filed in the office of the county. Laws of Virginia 1911, c. 1669-1670
Washington The superior court of any county, upon the application of any one under oath alleging that any person by reason of insanity is unsafe to be at large, must have such person before him, and summon witnesses and two reputable physicians before whom the judge must examine the charge, unless the accused or any one in his behalf demands that the question of insanity be decided by a jury. If no jury is demanded, and the physicians certify under oath that the person examined is insane, and the case is of a recent or curable character, or that the insane person is of a homicidal, suicidal or incendiary disposition, or that he would be dangerous to his own life, or the lives and property of the community in which he may live, the judge must commit him to one of the hospitals for the insane if he believe that the proper facts of insanity have been established. Codes and Statutes of Washington, 1909, c. 5960
Wisconsin Application made by three respectable citizens to the judge of the county court for a judicial inquiry as to his mental condition and for an order of commitment to some hospital or asylum for the insane. The judge must appoint two competent and disinterested physicians to examine the person. They must be graduates of a legally incorporated medical school or licensed to practice medicine in the state, and must have had at least two years’ experience as physicians in an insane hospital, and be registered by the county judge as qualified. Before making an examination, which may be held in the presence of the judge, the physicians must, if it seems expedient, notify the person to be examined that application has been made for an inquiry into his mental condition, but may withhold notice and the names of the applicants if it seems best, in which case they must state their reasons to the judge. The sworn report of the physicians must consist of answers to questions prescribed by law and are to be made in each case, whether the question of insanity is tried before a jury or otherwise, and must be forwarded with the commitment papers to the hospital superintendent. Laws of Wisconsin 1911, c. 585
Source Koren J (1912) Summaries of Laws Relating to the Commitment and Care of the Insane in the United States. New York, NY: The National Committee for Mental Hygiene.

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