7. Those who are so weakened by age or by disease as to require the
attendance of a nurse, or to threaten the speedy dissolution of life,
or who are so lame as to require the assistance of a crutch.
_Certificate to be signed by the Minister and Parish Officers, and also
by some Relation or Friend of the Lunatic._
We, whose names are hereunder subscribed, the minister and
churchwardens or overseers of the parish of ----, in the county of
----, and ----, of the parish of ----, in the county of ----, the [here
insert the degree of relationship, if any], of ----, in whose behalf
the present petition is presented, having carefully read over the above
seven regulations, do hereby certify, to the best of our knowledge and
belief, that the said ----, who has resided in this parish for ---- or
upwards, now last past, is a lunatic and has [here insert whether the
lunatic has or has not received parochial support] received alms from
such parish, is not in any of the states or conditions above-named, but
is in every respect a proper object for Bethlem Hospital. Witness our
hands, this ---- day of ---- 182-.
} Minister.
} Churchwardens.
} Overseers.
} Relation or
} Friend.
_Certificate of Insanity._
I, the underwritten ----, of the parish of ----, in the county of ----,
do certify, that I have examined ----, of the parish of ----, in the
county of ----, and that such person is a lunatic, and is not within
any of the foregoing seven regulations, which are declared to render
patients inadmissible at Bethlem Hospital; and I further certify, that
I have given to the friends of the said lunatic a letter addressed
to the physicians of Bethlem Hospital, containing a statement of the
particulars of such patient’s case, as far I am acquainted with it.
Witness my hand, the ---- of ----.
*⁎* This certificate is to be signed by the physician, surgeon, or
apothecary, who has visited the patient.
_Affidavit._
A. B., maketh oath and saith, that he did see the above-named minister,
parish officer, relative, or friend, and medical practitioner,
severally sign their names to the above certificates.
Sworn the ---- day of ----, 182-, before ----.
*⁎* The person making this affidavit must sign his name above this note.
* * * * *
When the person or persons in whose presence the foregoing certificates
shall have been signed, has made oath before a magistrate pursuant to
the foregoing forms, the petition at the end of these instructions may
be filled up, and directed to the steward of Bethlem Hospital.
On the following Thursday they will be considered by the governors,
when the petitioner, or some one who is acquainted with the facts,
must attend at the hospital, at ten o’clock in the morning, to give
any further information that may be required, and to learn whether the
lunatic can be admitted; but such lunatic must not be brought to the
hospital until directions are given for that purpose.
If the case be found to correspond with the petition and certificates,
and there be a vacancy, the lunatic may be admitted on the following
Thursday; and if no vacancy, the name will be placed on the list, and
the patient will be admitted in turn.
On the day appointed for bringing up the lunatic, two respectable
housekeepers, residing within the bills of mortality, must attend at
the hospital at ten o’clock in the morning, and enter into a bond of
£100, to take the lunatic away whenever the committee shall think
proper to direct his or her discharge; as well as to pay the expense
of burial if the lunatic should die in the hospital. And the names and
places of abode of such securities must be left three days before, in
writing, with the porter of Bridewell Hospital in New Bridge Street,
Blackfriars.
* * * * *
N.B. No governor, officer, or servant of the hospital, can be security
for any patient.