Civil Confinement in Continental Europe (1838-1905)

During the second half of the nineteenth century, much of continental Europe witnessed a period of significant social, political, and technological change. In the history of disability and mental health, these decades are considered the zenith of the institutionalization movement. As a protective and supposedly restorative space, the institution epitomized generations of state-driven policies for secluding different forms of social deviances into appropriate establishments, i.e. workhouses for indigents, penitentiaries for criminals, reformatories for young delinquents, hospitals for “habitual drunkards”, asylums for “idiotic children”, “colonies for the mentally defectives”, and of course, lunatic asylums.

In the case of lunatic asylums, governments early realized the need to regulate the process of confinement so as to avoid potential violations of the newly affirmed inviolability of individuals as citizens of a nation. By the end of the century, most European powers had outlined specific provisions for the “safe and speedy” committal of individuals into both private and public asylums.

This map of nineteenth-century Europe highlights the year when a major legislation on lunacy was approved. In addition, the three different colours divide the continent according to the features of civil confinement as prescribed by the law.

  1. Yellow stands for Joint Medical and Lay Judgement. This category includes all states where the determination of insanity took the shape of a joint statement performed by lay people, public officials, and physicians. Generally, states falling in this group mandated the insanity of individuals to be decided before a jury which included at least one doctor of medicine. Because the examination and the decision was collective, the law admitted no asymmetry between the medical and the lay opinion.
  2. Navy stands for Priority to 1 Physician. This category includes all states that required individuals to be individually examined by one doctor who produced a certificate of insanity. Although it was mostly up to judges, justices of the peace, or commissioners to appoint a general practitioner, civil confinement in these states required the expert opinion of one physician.
  3. Blue stands for Priority to 2 Physicians. This category includes all states that required individuals to be separately examined by two medical practitioner who produced certificates of insanity. Just like in the previous case, it was judges, justices of the peace, or commissioners who appointed practitioners, but confinement in these states required the expert opinion of two separate physicians.

Continental System (1914)

Primary Sources

The following table includes the central provisions for civil confinement as laid out by the original laws. Where primary sources proved inaccessible, I have included sections from legal scholars or public administrators who compiled a collection of European lunacy laws during the second half of the nineteenth century. A link to the original PDF for the cited laws is also provided.

Joint Medical and Lay Judgement Russia Burdett, 1891: [only private establishments] «Idiots and lunatics in private establishments may be subjected to an examination in due form on application to that effect from competent persons—namely, parents, guardians, trustees, or heirs. […] immediately submit the case to the local medical authorities, and the latter report thereon without delay to the governor. […] Any family in which there is an idiot or a lunatic person has the right to apply to the local authorities for the patient to be officially examined. This is done in cities by the medical department of the counts- administration in the presence of the governor, the vice-governor, the president of the district court of law or his substitute, the vice-president, or one of the judges, the prosecutor-general or his secretary, one of the local magistrates. In the port towns of the Government-General of New Russia and Bessarabia lunatics and idiots of noble blood are examined by medical men of the official staff in the presence of the local grand police masters, the president of the nobility of the district, and one or two members of the local committee of public protection, where such exists. If the patient belongs to the merchant class or any other, his or her examination must be attended by the president of the commercial court, where such exists, the mayor and two members of the magistracy» (606)

Harrison 1884: provisions of exculpation in cases of criminal lunatics.

Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.

Harrison GL (1884) Legislation on Insanity. A Collection of All the Lunacy Laws of the States and Territories of the United States to the Year 1883, Inclusive. Philadelphia, PA: Privately Printed.

Chaloner JA (1906) The Lunacy Law of the World. Roanoke Rapids, N.C.: Palmetto Press.

Criminal Code 1847

Priority to the Judgement of 1 Physician France

(Algeria and Tunisia by 1920)

Art. 8. — «Les chefs ou préposés responsables des établissements publics et les directeurs des établissements privés et consacrés aux aliénés ne pourront recevoir une personne atteinte d’aliénaIon mentale, s’il ne leur est remis :

1) Une demande d’admission contenant les noms, profession, âge et domicile, tant de la personne qui la formera que de celle dont le placement sera réclamé, et l’indicaIon du degré de parenté ou, à défaut, de la nature des relatons qui existent entre elles.

La demande sera écrite et signée par celui qui la formera, et, s’il ne sait pas écrire, elle sera reçue par le maire ou le commissaire de police, qui en donnera acte.

Les chefs, préposés ou directeurs, devront s’assurer, sous leur responsabilité, de l’individualité de la personne qui aura formé la demande, lorsque cette demande n’aura pas été reçue par le maire ou le commissaire de police.

Si la demande d’admission est formée par le tuteur d’un interdit, il devra fournir, à l’appui, un extrait du jugement d’interdiction ;

2) Un certificat de médecin constatant l’état mental de la personne à placer, et indiquant les particularités de sa maladie et la nécessité de faire traiter la personne désignée dans un établissement d’aliénés, et de l’y tenir renfermée.

Ce certificat ne pourra être admis, s’il a été délivré plus de quinze jours avant sa remise au chef ou directeur ; s’il est signé d’un médecin attaché à l’établissement, ou si le médecin signataire est parent ou allié, au second degré inclusivement, des chefs ou propriétaires de l’établissement, ou de la personne qui fera effectuer le placement.

En cas d’urgence, les chefs des établissements publics pourront se dispenser d’exiger le certificat du médecin ;

3) Le passeport ou toute autre pièce propre à constater l’individualité de la personne à placer»

Art. 19: «Art. 19. — En cas de danger imminent, attesté par le certificat d’un médecin ou par la notoriété publique, les commissaires de police à Paris, et les maires dans les autres communes, ordonneront, à l’égard des personnes atteintes d’aliénaIon mentale, toutes les mesures provisoires nécessaires, à la charge d’en référer dans les vingt-quatre heures au préfet, qui statuera sans délai»

Loi nº 7443 sur les aliénés du 30 juin 1838
Belgium 1850 Art. 7: «Le chef d’un établissement ne pourra recevoir aucune personne atteinte d’aliénation mentale que:

  1. Sur une demande écrite d’admission du tuteur d’un interdit […]
  2. Sur une demande d’admission de l’autorité locale du domicile de secours d’un aliéné indigent
  3. En vertu d’un arrête de collocation pris par l’autorité locale compétente
  4. En execution d’un réquisitoire d’un officier du ministère public
  5. Sur une demande d’admission de suite personne intéressée indiquant la nature des relations
  6. En vertu d’un arrêté de la députation permanente du conseil provincial

Art. 8: «Dans les cas n. 2,3,4,5 et 6 de l’article précédent, il devra être produit un certificat constatant l’état mental de la personne à placer et indiquante les particularités de la maladie [Modèle C]. Ce certificat pour être admis, devra avoir moins de quinze jours de date et être délivré par un médecin non attaché à l’établissement.

Néanmoins, en cas d’urgence, le certificate du médecine ne sera pas exigé au moment de la réception de l’aliéné, mais il devra dans ce cas être délivré dans le vingt-quatre heures»

1851 Art. 39: «Le certificat médical prescrit à l’art. 8 de la loi du 18 juin 1850 mentionnera autant que possible l’époque de l’invasion de la maladie, sa nature, sa durée et ses caractères essentiels, si l’aliéné a été soumis à un traitement et généralement toutes les circonstances propres ò faire apprécier l’état du malade.

A cet certificate sera joint un bulletin confidentiel mis sous enveloppe et cacheté, indiquant la cause connue ou présumée de la maladie, et si des membres de la famille de l’aliéné ont été ou sont atteints d’une maladie mentale [Modèle C].

Les certificats concernant les aliénés indigents sont délivrés gratuitement par les médecins des pauvres de la localité où ils se trouvent»

1873-74 [same provisions as 1850-51]

1885: «Le minster de la justice, […] Attendu que l’expérience a démontré la nécessité d’apporter des modifications à la formule du certificat médical annexé au dit arrêté, Arrête:

Article unique. La formule de certificate médical annexée à l’arrêté ministériel du 26 octobre 1874 (modèle l) est modifiée comme suit:

‘Je soussigné, docteur en médecine, etc., certifie avoir personnellement vu, exploré et interrogé le nommé, né à, domicilié à, et déclare avoir constaté qu’il est atteint d’une maladie mentale qui se caractérise par les symptômes suivants: …

Il est, en conséquence, indispensable, tant dans l’intérêt de sa santé que de la sécurité publique, de l… colloquer dans un établissement spécial, pour y être soumis au traitement que réclame son état’

Le bulletin confidentiel (modèle I) doit toujours être joint, sous enveloppe cachetée au certificat médical. Les commissions d’inspection des asiles d’aliénés du royaume sont chargées de l’exécution du présent arrête’»

Wouters, 1892: «L’autorité administrative s’est plainte à diverses reprises du laconisme des certificates médicaux qui rédigés d’une manière trop concise ne répondent plus à leur destination. Le certificat médical doit mentionner autant que possible, l’époque de l’invasion de la maladie sa nature, sa durée et ses caractères essentiels, si l’aliéné a été soumis à un traitement et généralement toutes le circonstances propres à faire apprécier état du malade»

«Le certificat médical doit être rigoureusement conçu dans les termes prescrits par l’arrêté ministériel du 25 août 1885 qui en détermine le modèle [Modèle H]. S’il est formulé d’une façon irrégulière, le directeur de l’établissement a le devoir de le faire modifier dans le plus bref délai avant d’en faire dresser une copie dans le registre matricule» (80)

«Au certificat médical doit être joint un bulletin confidentiel»

Loi du 18 Juin 1850

Règlement Général et Organique sur le Régime des Aliénés en Application de la Loi du 18 Juin 1850, Arrêté Royal du 1 Mai 1851

Loi du 28 Décembre 1873-25 Janvier 1874

Arrêté Ministériel du 25 Août 1885

Wouters T (1892) Du Régime Des Aliénés En Belgique: Commentaire Pratique de La Loi Du 28 Décembre 1873 – 25 Janvier 1874. Gand: Hoste.

Netherlands Burdett, 1891: «Application for the admission of a patient into a lunatic asylum must be made in writing to the judge of the court of the district in which the patient resides, by one of his relations or his guardian, or, in their default, by the officer of justice of the said court to the president of the court. […] Such authorisation can only be granted by the judge or the president on the production of a medical certificate as to the insanity of the patient, and the judge or president is empowered, before giving his decision, to call before him and examine both the patient and the person who has applied for his admission to an asylum, but the authorisation for the admission can, in the first instance, only be given provisionally. and subject to confirmation, and is not communicated to the patient. In urgent cases, a lunatic may be placed in safe keeping by the burgomaster of the commune in which he is resident» Act Relating to the Regulation of the Governmental Inspection of Lunatics, 1884 [translated]

Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.

Denmark Burdett 1891: «For the admission of a lunatic into a public asylum a certificate from a competent medical practitioner is required certifying that the individual in question is insane. […] The same certificate as is required in the case of the admission of a lunatic into a public asylum is required when application is made to admit him or her into a private asylum» (584) Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.
Sweden Burdett 1891: «If any person show signs of madness it is the duty of his natural guardians or nearest friends, or, should these neglect to do so, of the mayor of the commune or police authorities, to have him at once examined by a doctor, and measures taken for his care. A request for the admission of a patient into a lunatic asylum must be sent in writing to the managing committee, accompanied by a certificate from a duly qualified physician, and by written information as to the person for whom entrance into the asylum is desired, issued by the clergyman of the parish, and signed by three persons, relatives if possible of the patient, or trustworthy persons who have seen a good deal of him» (611) Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.

Royal Ordinance of the 2nd November 1883

Norway Burdett 1891 [peculiar]: «Before a patient can be placed in a lunatic asylum he must be examined by the medical man in charge of that asylum, and an appeal may be made against his decision to the special committee of control under which the said asylum is placed. The said committee consists of three members nominated by the Government, of which one, at least, must be a duly qualified medical practitioner» (612) Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.
Austria Burdett 1891: «No person can be admitted into a public asylum without the production to the medical director thereof of a certificate of an official or practising physician certifying that the patient to be admitted is insane. Each such admission must be notified to the competent Court of Justice of the district in which the asylum is situated» (581) Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.
Germany (Prussia)

Brandenburg

Harrison 1884: «Petitions for reception of a patient must be made to the land-director through the intercession of the home police office.

The petition is to be accompanied by:

  1. Testimony given and sworn to by an approved physician, answering the questions concerning the nature of the mental disease, in response to the questions contained in the interrogatories published by the land-director.
  2. By a testimonial, made out by the home police office, in accordance with the interrogatories of the land-director, stating the personal affairs of the patient and of his property, stating whether he belongs to the province, whether he is entitled for support to any place, and where, and how far his expenses can be paid form the income of his property, or by third parties.
  3. Either: the declaration of the patient’s father, wife or husband, guardian, or legal representative, given under oath before the home police office that his reception to a public lunatic asylum is desired; or the testimonial of the home police office; the certificate of the police office that […] an application can be had; […] the testimony of the home police office that the patient is not well-cared for; …
  4. Either a certified written declaration of the legal representative of the patient or of a third party, […].

Whether a patient is to be received shall be decided by the land-director after hearing the testimony of the director of one of the public asylums, and in case of a complaint, by the provincial delegation»

«In case of emergency the land-director may, upon the ground of a medical testimony, temporarily admit the patient, if, in case requisites for reception should not be furnished within the required time» (1048)

Burdett 1891: «Applications for admission on behalf of a lunatic are to be made to the director of the province through the intermediary of the local police authorities. With the application there must be transmitted:

1. A certificate under oath from an approved medical man, stating the existence and nature of the malady, with answers to the questions set out in the forms supplied by the said director;

2. A statement on the form prescribed by the police authorities of his personal and pecuniary circumstances, showing if he is a native of the province, if he belongs to any and what parish, and how far his expenses can be met from his own means, or from other sources;

3. Either(a) the document delivered to the police on the part of his representatives, stating his desire to be taken into an asylum; or (b) a statement by the police that no legal representative is forthcoming, but that the nearest known relative is a consenting party; or (c) in default of representative or relative a statement showing that from his helpless condition his reception into such an institution is necessary; or (d) (where the aforesaid parties resist proof) that he cannot be sufficiently cared for, and that his incarceration is already determined by the Court;

4. Either a solemn declaration in writing on the part of his legal representative, or some third party, that they bind themselves to duly fulfil all stipulated obligations, the police showing that their means are adequate to that end; or  a similar declaration on the part of his parish» (592)

Harrison GL (1884) Legislation on Insanity. A Collection of All the Lunacy Laws of the States and Territories of the United States to the Year 1883, Inclusive. Philadelphia, PA: Privately Printed.

Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.

Regulations for the Insane Asylums of the Province of Brandenburg in force since July 16th 1879.

Germany (Prussia)

Schleswig-Holstein

Harrison 1884: «Petitions for the admission fo the insane must be made in writing to the directors of the establishment. Except in the case of free places, the petition must be accompanied when the patient is to be taken care of at public expense by a written certificate of the respective community, wherein the latter shall make themselves responsible for the expenses of treatment.

Application for the reception of patients, who pay for themselves, may be made by the legal representative of the same.

The petitions for admission must further be accompanied:

  1. by a complete history of the case, in a sealed envelope according to the regulations of September 1st 1874 (Amtsblatt, 1874, piece 44, No. 1168)
  2. a medical certificate
  3. certificate of baptism or birth
  4. when the person is to be a private patient, an explanation concerning the class of treatment into which he is to be received» (1053)
Harrison GL (1884) Legislation on Insanity. A Collection of All the Lunacy Laws of the States and Territories of the United States to the Year 1883, Inclusive. Philadelphia, PA: Privately Printed.

Compendium of the Regulation concerning the Admission and Discharge of Insane at the Provincial Insane Asylum at Schleswig, May 3rd 1879

Germany (Prussia)

Sachsen(Saxony)/Anhalt

Harrison 1884: «Petitions for admission must be in the first place issued by the representative, etc., of the patient and directed to the legal authorities. When the patients have no relatives, etc., the magistrates themselves must issue the petition. Petitions must be accompanied by:

  1. A medical certificate, answering the questions of the model question paper; or in the case of great urgency the simple statement of the respective physician. […] Any statements of family matters of the patient, that are to be kept generally secret, but must be known by the doctors of the establishment must be sent to he director in a sealed envelope
  2. A complete description of the patient and in case of dangerousness the police certificate
  3. A copy of any judicial declaration of insanity of the patient
  4. A certificate, stating whether the patient is entitled for support to the committee on charity or whether he is to be maintain by his relatives, representatives, etc.
  5. If the patient is to be paid for, altogether or partly by his relations, etc., a guarantee to that effect must accompany the petition.

The land-director shall give his official decision concerning the reception of the patient» (1059)

Harrison GL (1884) Legislation on Insanity. A Collection of All the Lunacy Laws of the States and Territories of the United States to the Year 1883, Inclusive. Philadelphia, PA: Privately Printed.

Regulations for the provincial insane establishments at Alt-Sherbitz near Schkenditz, and Nietelben near Halle, March 1 1879

Germany (Prussia)

Rheinland

Harrison 1884: «When a civilian patient is to be received into the normal class, the application for reception must be made by the home police office, accompanied by the following documents:

  1. A medical question-paper duly answered [Form used also in Baden]
  2. The exact personal history stating place of birth, birthday, religious profession, domicile, occupation, name of the patient, name of husband or wife, occupation and domicile of his parents
  3. An agreement in which the respective communities bind themselves to remove the patient within three weeks after a request
  4. A paper stating their liability for any expenses of treatment

Concerning the reception of a soldier from the sergeant-major downward, into a normal class, such applications for admission myst be made by the respective military authorities accompanied by the above mentioned documents» (1068)

Harrison GL (1884) Legislation on Insanity. A Collection of All the Lunacy Laws of the States and Territories of the United States to the Year 1883, Inclusive. Philadelphia, PA: Privately Printed.

Conditions under which insane persons are received into the Rhenish Provincial Insane Asylums, May 24 1879

Germany (Prussia)

Westfalen

/Aix la Chapelle (Aachen)

Harrison 1884: «No one shall be received into an asylum without a written order (which shall be issued only when public interests and security demand it); or at least, the written assent of the  police authorities of the domicile of the person to be received, or of the place where the patient has been arrested in behalf of public security; or in consequence of a petition of his relatives; the person to be received must also be furnished with a certificate of a physician officially approved by the respective police officers as being reliable and able to judge the condition of the malady of the patient, stating also the reasons which have induced the physician to decide the patient insane, and the necessity or desirability of the reception of the patient into the asylum, and the statement whether the patient is considered curable or incurable» (1072) Harrison GL (1884) Legislation on Insanity. A Collection of All the Lunacy Laws of the States and Territories of the United States to the Year 1883, Inclusive. Philadelphia, PA: Privately Printed.

Police Regulation for the District of Aix la Chapelle, concerning Admission into Insane Asylums, and the Police Control of the State Asylums, Given April 18th 1879, Medical Gesetzb, 1879, p. 180.

Germany

Baden

Harrison 1884: «The admission of patients takes place generally only upon request of the nearest relative or, when the patient is a minor or under guardianship, of the guardina. The request must either be submitted in writing, to the district physician of the domicile of the patient, or it must be place on file. It must contain the following points of explanation: Whether the persons who seek the admission of the patient are ready to pay his board out of their own means and into what class of treatment they wish him to be received; who is responsible for the payment and who represents the patient in his relations with the asylum; or, […] who is bound to take care of and represent the patient. Such request must be accompanied by documents as described in the regulations of the Rhine province of Prussia.

The district authorities must forward the request for admission together with the accompanying document to the directors of the asylum.

The directors shall examine the documents sent to them and shall try to have everything added which seems to be necessary to their completion, and they shall send the documents to the ministry of the interior, with the further information as to whether the patient is to be received, and into what class of treatment; whether the patient will be paid for , and by whom.

In cases of emergency the directors may arrange for the reception of patients whose admission is desired by their relatives without the usual formalities. In the request addressed to the director, the disability must be particularly stated and certified by an approved physician or by the proper legal authorities.

The ministry will decide concerning the admission of the patient and the class of treatment into which he is to be received.

All papers concerning the admission, shall be sent to the ministry of the interior, who shall examine them. These papers shall be returned by the ministry of the interior to the directors of the asylum as soon as practicable» (1085)

Insane not in asylum Ordinance: «Once in every five years, in the latter half of the month of September, the mayor shall make out a list showing hte personal circumstances, the manner of treatment, etc., of the deranged and epileptic persons in the community, who are not in a hospital or asylum. […] The district authorities shall send two copies of the list, after examination, to the district physician. The latter shall examine the different lists, cause the necessary corrections to be made, and compose from them a general list, comprehending the whole district, according to the forms added under (b) and send these, together with copies of the special lists, to the ministry. In his report the district physician shall communicate his observations and investigations concerning the occurrences of mental disease and the care of insane in his district, and all arrangements relating thereto. […] The cause of epidemic occurrences of mental disease, shall be investigated by the district physician, who shall report to the ministry the possible means of prevention» (1091)

Harrison GL (1884) Legislation on Insanity. A Collection of All the Lunacy Laws of the States and Territories of the United States to the Year 1883, Inclusive. Philadelphia, PA: Privately Printed.

Regulations for the Insane Asylum of Heidelberg, October 12, 1878

Regulation concerning the Insane not Placed within State Asylum, October 4, 1879

Switzerland

Canton of Geneva

Burdertt 1891: «There is no general federal law relating to lunacy matters for this Republic, each of those cantons which possesses a public asylum having its own law on the subject. And as the differences between most of those laws are trifling and unimportant, it is only proposed to notice those of a few of the principal cantons. Twelve of the twenty-two cantons, viz., Lucerne, Fribourg, Soleure, Bale-Ville, Neuchatel, Zurich, Berne, St. Gall, Argovie, Thurgovie, Vaud, and Geneva possess public asylums; while in the latter, seven private asylums, some on a large scale, exist also. None of the remaining ten cantons have any asylum at all; but the lunatics from them are sent, under arrangements as to their costs and charges, to the public asylums of neighbouring cantons, or to private asylums» (614)

Geneva: «No lunatic can be admitted into an asylum except upon the order of the chief of the department of police. This may be granted upon the application of relations of the patient, or may be issued by the chief of police, ex officio. He must, however, in the first place, either personally, or through the president of the commune, or other delegate, admit the patient to an interview. This interview, however, may be dispensed with upon the written recommendation of a doctor of the faculty of Geneva, or other recognised officer of health» (614)

Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.
Switzerland

Canton of Zurich

Burdett 1891: «The following are the requisitions for the reception of a patient.

1. For all patients : —
(a) A certificate of origin.
(b) Security for payment of fees.

2. For patients admitted not at their own request, but upon the application of relations or guardians:

(a) A written agreement of the said relations, etc., showing the class (according to means) in which it is desired that the patient should be included.

(b) A medical certificate of insanity.

3. For patients received on police authority, without regard to the wishes of their relations :—

(a) A prefectorial minute, declaring the lunatic to be dangerous to public safety, and the absence of other means to ensure his being taken care of.

(b) A medical certificate to the same effect. […]

A patient may be admitted provisionally, even without the usual formalities, if delay appears to be dangerous, but, in every instance, a medical certificate must be forthcoming, and the other requirements must be complied with within eight days, or the patient must be discharged» (617)

Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.

Law of 1874

The Burgholzi Asylum is governed by a regulation of the Council of State of the 22nd November 1879.

Switzerland

Canton of Lucerne

Burdett, 1891: «Regulations are very similar to those in force in the Zurich asylums. Application for admission must be supported by a medical certificate giving details of the past history and present condition of the patient, and a certificate signed by his nearest relations and also by the chief authority of his commune, testifying to his being generally considered of unsound mind» (618) Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.

Decree of the Council of State in 1873 for the public asylum of the canton established at St. Urban.

Switzerland

Canton of Vaud

Burdett, 1891, Regulation 1860: «Patients can only be admitted after exhibition to the prefect of the following documents:

(a) A medical certificate drawn up and signed by a licensed physician personally known to the magistrate.

(b) The “acte d’origine” of the patient.
(c) The petition signed by the members of his or her family

claiming admittance.

Whenever the petition for admission comes from the manager or director himself, the medical certificate must be given by a physician unconnected with the asylum»

Regulation of 1862: «The Regulation of 1862 for public is the same as that for private asylums, with the exception that as regards admission, in addition to the documents mentioned, a decision of the Council of State taken upon the recommendation of the chief medical officer attached to the Sanitary Police is required» (620)

Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.

Regulation for Private Asylums 1860

Regulation for Public Asylums 1862

Switzerland

Canton of Berne

Burdett 1891: «Regulation of 1865: «The following are the requisites for the admission of a lunatic :

1. A medical certificate testifying to the unsoundness of mind of the patient. The doctor signing this certificate must not be the proprietor of the asylum, nor stand within a certain degree of relationship to him.

2. A written declaration of the next of kin or guardian, to the effect that the patient’s admission is wished for.

3. A certificate signed by the pastor and by the major of the patient’s domicile, giving

(a) details as to his age, profession, social standing, etc.

(b) a declaration that his removal to an asylum is within their knowledge.

4. A visa of the prefect, certifying:

(a) that the three foregoing documents have been submitted to him ; and

(b) that he approves of their tenor or the contrary.

All these documents must, further, be submitted within three days to the prefect of the district within which the asylum is situated.

In cases of urgency, when a patient is received without notice into an asylum, the prefect of the district must be notified of the fact within twenty-four hours, and the requisite documents must be produced within fourteen days» (619)

Regulation of 1884: «Under the Regulations of 1884, applications for admission to the cantonal asylum must be accompanied by two certificates, the one signed by a doctor and setting forth the details of the mental condition of the patient ; the other by the pastor, the President of the commune, and the next of kin or guardians, giving all other information as to the patient» (620)

Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.

In this canton the subject of lunacy is dealt with under two codes of Regulations, the one enacted in 1865 for private asylums; the other enacted in 1884 for the public asylum of the canton established at Waldaa.

Italy 1904 Art. 2: «L’ammissione degli alienati nei manicomi deve essere chiesta dai parenti, tutori o protutori e può esserlo da chiunque altro nello interesse degli infermi e della società.

Essa è autorizzata in via provvisoria dal pretore sulla presentazione di un certificato medico e di un atto di notorietà, redatti in conformità delle norme stabilite dal Regolamento, ed in via definitiva dal tribunale in Camera di Consiglio sulla istanza del pubblico ministero in base alla relazione del Direttore del manicomio e dopo un periodo di osservazione che non potrà eccedere in un complesso un mese. Ogni manicomio dovrà avere un locale distinto e reparto per accogliere i ricoverati in via provvisoria.

L’autorità locale di Pubblica Sicurezza può in caso d’urgenza, ordinare il ricorso in via provvisoria in base a certificato medico ma è obbligata a riferirne entro tre giorni al Procuratore del Re, trasmettendogli in cennato documento»

1905 Art. 37: «La domanda pel ricovero in un manicomio, o per l’autorizzazione della cura in casa privata d’un alienato, deve essere presentata al pretore o all’autorità locale di pubblica sicurezza e firmata da chi la produce e portare l’indicazione del domicilio, della condizione del richiedente e dei suoi rapporti con l’alienato, e il visto del sindaco del Comune dove questi dimora. Insieme con la domanda, le persone indicate nell’art. 37 debbono presentare il certificato medico e, se non trattasi di caso d’urgenza, l’atto di notorietà di cui al secondo comma dell’art. 2 della legge.

Art. 38: «II certificato medico deve essere rilasciato da un medico esercente non vincolato da legami di parentela, entro il quarto grado civile, col malato, o col direttore o proprietario del manicomio, né appartenente al manicomio stesso, o alla casa di salute avente reparti anche per alienati»

Art. 39: «Il certificato medico deve accertare:
a) l’indole della infermità mentale, indicando i sintomi, l’origine, il decorso di essa, e via dicendo;

b) la necessità di ricoverare il malato nel manicomio, attestando, ove occorra, la necessità di ricovero d’urgenza

c) la possibilità di trasportare l’alienato al manicomio, per le condizioni fisiche in cui si trova senza gravo nocumento della sua salute.

Il certificato dev’essere rilasciato in duplice copia, una per uso dell’autorità giudiziaria o di pubblica sicurezza, e l’altra per uso del direttore del manicomio, a norma degli articoli seguenti»
Art. 41: «Il certificato medico e l’atto di notorietà non sono più validi se presentati dopo quindici giorni dalla loro data»

Art. 42: «L’autorità locale di pubblica sicurezza, appena viene a conoscenza in seguito a denunzia od altrimenti di un caso di alienazione mentale, se scorge in esso l’assoluta urgenza di provvedere immediatamente senza attendere l’autorizzazione del ricovero provvisorio dal pretore, dispone con ordinanza motivata il ricovero provvisorio stesso in base al certificato medico»

Anfosso 1907: «Sonvi due procedure per l’ammissione; queste hanno di comune non solo la domanda, che deve essere inoltrata dagli interessati, ma hanno eziandio di comune il certificato medico che ne forma la base. Nella legislazione francese (art. 8 della legge 30 giugno 1838) il direttore dello stabilimento pubblico può in caso d’urgenza fare a meno del certificato medico; nella nostra legislazione, invece, si fa più rigorosi, e , salvo il caso di presentazione spontanea, occorre sempre il certificato medico. Questo certificato equivale al giudizio emesso dall’uomo di scienza sulle condizioni intellettuali del ricoverando e sotto questo rapporto è fondamental dell’ammissione in manicomio. Deve quindi rispondere a due condizioni essenziali: 1) emanare da un medico, il quale pei suoi requisiti personali e pei suoi rapporti col ricoverando, possa dare un giudizio sicuro; 2) nel suo intrinseco rispondere alle esigenze del legislatore che volle esser certo che nessuna persona possa essere indebitamente ricoverata in manicomio» (109)

«Suo contenuto: Il certificato medico è stato imposto come condizione assoluta di ogni ammessione in manicomio, perché il legislatore ha voluto, in ogni caso, che la privazione della libertà sia preceduta da un giudizio tecnico che la dichiari necessaria. Da ciò si comprende quale importanza capitale abbia questo certificato e quanto grande sia la responsabilità che grava sul sanitario. Il medico dovrà perciò ricercare e studiare l’origine della malattia, raccogliendo, oltre le generalità dell’ammalato, le indicazioni relative alla sua costituzione fisica, al genere di vita, nonché le malattie in precedenza patite. Curerà l’indagine sui precedenti gentilizi e potrà nelle sue ricerche essere validamente aiutato dall’opera del Morselli Semeiottica delle malattie mentali; farà in modo che il suo certificato riproduca anche pei profani, lo studio coscienzioso che egli ha fatto della persona sottoposta al suo esame. I certificati medici a base di pochi termini più o meno scientifici, gettati giù con stile telegrafico, non sono tollerati ormai più da alcuno poiché in cosa delicata quanto la salute ciascuno ha diritto di vederci chiaro! È passato il tempo in cui il medico poteva nascondere la propria responsabilità sotto il velame di versi strani, oggi – a parte la maggior diffusione dell’istruzione – tutti vogliono conoscere se il medico sappia realmente o se pure giudichi a tastoni. Il suo studio deve esser fatto indipendentemente da qualsiasi dichiarazione di terzi, i quali non sempre sono in realtà indifferenti e disinteressati. Con questa cura meticolosa il medico avrà anzitutto la coscienza tranquilla per aver fatto il suo dovere e poi si metterà al coperto contro le non impossibili accuse. Viviamo in un basso mondo e talvolta, anche in buona fede e per eccesso di un male inteso sentimento di buon cuore, si può esser tratti a violare il proprio dovere positivo per omaggio a doveri ideali. Non è inutile quindi ricordare l’art. 289 del Codice penale in cui può incappare un medico per leggerezza: ‘Il medico, il chirurgo od altro ufficiale di sanità, che rilascia per solo favore un falso attestato […] è punto colla reclusione sino a quindici giorni o con la multa da lire cento a lire mille’» (112)

«Negligente sarebbe il medico che trascurasse palesemente quei mezzi d’indagine che fossero alla portata di mano; imprudente sarebbe se accogliesse o tenesse per buone o riproducesse nel suo certificato le dichiarazioni di terzi o senza controllarne la verità; colpevole sarebbe infine sarebbe se, per propria imperizia, scambiasse per infermità di mente il passeggiero disturbo psichico causato da malattia acuta. […] Anche senza essersi approfondito in psichiatria qualunque medico di qualsiasi comunello, non solo per gli studi fatti all’Università ma anche col semplice sussidio di pubblicazioni periodiche , può formarsi e mantenersi un corredo di nozioni scientifiche atto a porlo al coperto da un grossolano errore professionale, quello che solo può indurre la sua responsabilità. Le conseguenze gravissime cui può esporsi una persona colla sua intempestiva chiusura in manicomio, già debbono rendere guardingo il medico nel rilasciare certificati di alienazione» (114)

1909: Articoli 36-41 same provisions as 1905

Legge 14 Febbraio 1904, n. 36 sui Manicomi e gli Alienati

Regolamento del 5 Marzo 1905 sull’Esecuzione della Legge 14 Febbraio 1904 n. 36

Nuovo Regolamento del 16 Agosto 1909 sull’Esecuzione della Legge 14 Febbraio 1904 n. 36

Anfosso L (1907) La Legislazione Italiana Sui Manicomi e Sugli Alienati. Torino: UTET.

Portugal Burdett, 1891: «The asylum at Lisbon (formerly a military school) was established in 1848 ; that at Oporto much later. […] Admission is only to be obtained by a judicial decree on the demand of the administrative authorities, at the previous request of some relatives or relative having the legal custody of the alleged lunatic, accompanied by a certificate of his or her insanity from a duly qualified medical man, and the depositions of witnesses to acts of his or her insanity.

The examination of the lunatic by the certifying physician must take place in the presence of a judge and witnesses. If the alleged lunatic has been previously legally declared to be of unsound mind the authorisation of a legally constituted family council is required in addition to the formalities mentioned above.

No certificate from any  medical man attached to the asylums, or related in any way to the alleged lunatic, is accepted. The medical director is bound to examine and watch the lunatic for the first fortnight after his admission in order to decide as to his true mental condition; at the expiration of that period the lunatic can be accepted definitely as a patient. In cases of urgent necessity, such as danger to the lunatic him- self or to those about him, the authorities may demand the admission of a lunatic into the asylum without any legal formality» (602)

Burdett HC (1891) Hospitals and Asylums of the World, Volume 1: Asylums History and Administration.London: John Churchill.
Priority to the Judgement of 2 Physicians Spain

(Also Cuba)

15 Mayo 1885, Art. 52: «El ingreso de los dementes lo ordena el Director general de Beneficencia y Sanidad.

Art. 53: «A la instancia solicitando el ingreso se acompañará una información hecha ante el Juez de primera instancia del domicilio del alienado, su curador ó familia, en que se acredite el estado de demencia y la conveniencia ó necesidad de su reclusion. Esta solicitud será suscrita por el pariente más cercano del enfermo, y de tratarse de persona casada, habrán de ser citados y oídos en la información en cónyuge y sus más próximos parientes» [no physicians here]

19 Mayo 1885, Art. 1: «La hospitalidad á los dementes se concederá en dos términos:

  1. De observación
  2. De reclusión definitiva

Art. 3: «Para que un presunto alienado pueda ser admitido en observation, será preciso que lo solicite el pariente más inmediato del enfermo, justificando la necesidad o conveniencia de la reclusión por medio de un certificado expedido por dos Doctores ó Licenciados en Medicina, visado por el Subdelegado de esta Facultad en el distrito é informado por el Alcalde.

Los Profesores del Medicina que expidan la certificación expresiva del estado del enfermo no podrán ser parientes dentro del cuarto grado civil de la persona que formule la petición, del Director administrativo ni de ninguno de los Facultativos del establecimiento en que deba efectuarse la observación.

Art. 5: «El ingreso en observation de dementes, en la forma establecida, no podrá tener efecto sino en casos de verdadera y notoria urgencia, declarados así en los informes del Alcade y Subdelegado de medicina. Mientras el presunto demente pueda permanecer en su casa sin peligro para los individuos de la familia, sin causar molestias excesivas a personas que vivan en las habitaciones contiguas, o sin perjuicio evidente para la salud del mismo pariente, no podrá ser recluido a menos que lo acuerde el Juzgado de primera instancia respectivo, previa la instrucción del oportuno expediente.

Art. 7: «Para la admisión definitiva de un demente será preciso expediente instruido ante el Juez de primera instancia, en el cual se justifique la enfermedad y la necesidad o conveniencia de la reclusion del alienado.

Art. 8: «Las peticiones, tanto de observation como de ingreso definitivo en un hospital, deberán hacerse por el pariente mas inmediato del dementes o de oficio si se trata de una person que carezca de familia.

Real Decreto 15 Mayo 1885, Reglamento Orgánico para el régimen y gobierno interior del manicomio de Santa Isabel de Leganés

Real Decreto 19 Mayo 1885

Real Decreto 23 Junio 1885

 

 

 

 

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