Chap. 102.—An ACT to amend and re-enact section sixteen hundred and
sixty-nine of the Code of Virginia, in reference to the proceedings before
a commission to ascertain insanity.

Approved March 9, 1910.

1. Be it enacted by the general assembly of Virginia, That section
sixteen hundred and sixty-nine of the Code of Virginia be amended so as
to read as follows:

$1669. 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,
shall issue his warrant ordering such person to be brought before him,
and he shall summon two licensed and reputable physicians (one of whom
shall, when practicable, be the physician of the suspected person, and
neither shall in any manner be related to him or have an interest in his
estate). The judge and the two physicians, or the justice and the two
physicians, shall constitute a commission to inquire whether such person
be insane and a suitable subject for a hospital for the care and treatment
of insane persons, and for that purpose the judge or the justice shall
summon witnesses. The physicians shall, in the presence of the judge
or the justice (if practicable), by personal examination of such person
and by inquiry, satisfy themselves and the judge or the justice as to the
mental condition of the person being examined. If the two physicians
do not agree, a third physician shall be summoned.

The deposition of all witnesses, physicians, et cetera, shall be taken
under oath.

The report of the commission, which shall be in writing, shall consist
of the following statements and questions and answers thereto, and of any
further information bearing on the insanitv of a person being examined:

State of Virginia,

County or city of ——_———_—__, to-wit:

Inquisition this day of —————,, nineteen hundred and '
by —————, judge or justice, and —-———, medical doctor, and ,
medical doctor, licensed physicians, now sitting upon the examination
ef —_———, suspected of being insane.

The depositions of the above physicians, and ——————, witnesses,

being first duly sworn, in answer to the following interrogatories, say:
Name of patient, ———_—_——_—_-.
If married and a female, maiden name,

Age, —————; color, ——, 3 sex, — - where born,

Present residence, —————_ ; how long lived in ‘present place of resi-
dence ? ——-——-;; place of residence for past two years, ————————

If of foreign birth, how long a resident of the United States?

Port of landing, —————-; date of landing,

Name of ship, ————————.

Birthplace of father, ; of mother,

Present occupation of patient,

Former occupation,

Education, liberal, —-———_ ; good, —————_; professional,

Read, —————;; write, ,

Civil condition, married, ; single,

Widowed, —————; divorced, :

Number of children had, if a female,

Age of youngest child, if the patient is a female,

Name and address of guardian, nearest friend or relative,

Relation of same to patient,

Nearest telegraph and railroad station or steamboat landing to said
friend or relative, —————.

Value of property of self or husband, —————; of parents, if the
patient is a minor,
Is the patient addicted to the intemperate use of intoxicating liquors,
tobacco, morphine, cocaine or other injurious drugs? ; if so, to
what extent ?

Is the patient addicted to any injurious, improper or immoral
habits ? —-—_—-.

If so, to what extent?

State fully and in detail any physical symptoms, injury or disease
from which the patient is at present suffering,

Is the patient affected by paralysis, —; dropsy, ;
blindness, ——————; deafness, ——-———_; dumbness, —-————; incon-
tinence of urine or feces, —————-; hysteria, 3 emaciation,
; insomnia, —————— ; cancer, —-————; tuberculosis,
pellagra, —————_; hernia, ; epilepsy, ——__—— ; pellagra,
——; hernia, —-————; uterine or pelvic disorders or pregnancy,

Is the patient now sick in bed?

Does the patient spit blood ?

Does the patient have night sweats?

Is patient now suffering from acute or chronic alcholism or delirium
tremens ?

When did the present attack of insanity begin?

What were the first symptoms ?

Were the symptoms gradual or rapid in onset ? ————.

State fully the present symptoms of insanity, particularly whether
the patient is violent, ————— ; destructive, ; untidy, ;
excited, —————_ ; depressed, ee homicidal, ee . suicidal,

If homicide or suicide has been attempted or threatened, state when
and in what manner, —————.

a If the patient has illusions, hallucinations or delusions, state what
ey are, —————.

‘Does the patient talk to himself ? —————-; assume peculiar atti-
tudes ? —————-; hear voices ? ——_——-; believe he is being persecuted ?
; state in what manner,

State any changes that have occurred in the condition of the mind
or body of the patient since the onset of the present attack of in-
sanity,

Has any restraint or confinement been imposed on the patient, the
nature and duration ?

Is the-patient now in jail? —____ if not, state in whose custody
said patient is, giving name, postoffice and telegraph address, distance
from telegraph office and railroad station,

If there have been any attacks of insanity previous to the present one,
when did they occur?

Give the duration, sy mptoms and character of each,

State the length of intervals between the attacks,

Was the patient entirely sane and rational between the attacks?

If the patient has ever been an inmate of any hospital or other place
of detention and treatment for the insane, state when, where and whether
he was discharged as recovered or otherwise,
If any of the patient’s family or near relatives are or have been
insane, mentally defective, epileptic, neurotic, alcoholic, tuberculous, et
cetera, state the facts,

The degree of consanguinity,

Whether maternal or paternal,

What, in the opinion of the examining physician, are the exciting
causes of the patient’s insanity ? —————..

The predisposing causes ? —————.

Name and address of physician who last attended patient ?

What treatment has been given?

With what effect ?

Is the patient normally below or above the average standard of in.
telligence ? —

Is the patient a congenital idiot or imbecile?

Can the patient count ten?

Could the patient ever read ? ————— ; write, —————.

Can he speak English?

Describe the appearance, manner “and all insane acts and speech o:
the patient during examination, —————.

State fully anything else bearing on the case as indicating in
sanity, —————.

Seal.
Seal.
Seal.
—_——_—_—- Seal.
Mediral doctor.
—_—_—_—— Seal.
Medical doctor.
Witnesses.
Commonwealth of Virginia,
County or city of ——————___, to-wit:
Whereas, — , who was suspected of being insane, was this da:
brought before us, —————-, judge or a justice of said county, an
and —————, two physicians (said —-————— being the phy
sician of said suspected person), constituting a commission to inquir
whether the said —-————— be insane and a suitable subject for a hospita

for the care and treatment of insane persons; and whereas, we, the sai
physicians, have, in the presence (as far as practicable) of the said judg
or justice, by personal examination of said —————, suspected of bein
insane, and inquiry and examination of the above named witnesses satis
fied ourselves and the said judge or justice as to the mental conditio:
of said —————, we, the said judge or justice and physicians, consti
tuting the commission aforesaid, do decide that the said ————— is in
sane, and ought to be confined in a hospital for the insane.

Given under our hands this ——- day of ———_—,, nineteen hundre
and

Commonwealth of Virginia,
County or city of ——__—_—__, to-wit:

To the —-———— of the —————- of ———-—, and to the superin-
tendent of the ————— State hospital, greeting:
Whereas, I, —————-,, judge or a justice of said county, or city of
» and ————-—,, two physicians (the said being the physician
of said —————_), constituting a commission of inquiry, et cetera, into
the sanity of said —————-, have this day adjudged the said

to be insane and a suitable subject for a hospital for the care and treat-
ment of insane persons, and a citizen of this State; and no person ap-
pearing before me to give bond, with sufficient security, to be approved
by me, payable to the Commonwealth with condition to restrain and take
proper care of the said insane person, without cost to the said Common-
wealth, until the cause of confinement shall cease, or the said insane per-
eon is delivered to the said sheriff or sergeant, to be proceeded with ac-
cording to law, I do, in the name of the said Commonwealth, command
you, the said sheriff or sergeant, to deliver the said ————, together with
this warrant, to the superintendent of the ————— State hospital, at

, that being the nearest appropriate hospital, or iv the duly
authorized agent of said hospital, to be delivered by him to the said

superintendent.
And you, the said superintendent, are hereby required to receive into
the said hospital, and into your care and charge, the said —————, to

be treated and cared for as an insane person.
And I do herewith transmit to you, the said superintendent, the inter-
rogatories and answers thereto, taken by said commission touching the

sanity of the said —————,, and also the adjudication of the sanity of
the said ————-—, a copy of each of which has this day been delivered
by me to the clerk of the ————— court of said county or city.

, nineteen hundred

day of

Given under my hand this

and

—____—________—_., Judge, or

—___________—_—., Justice of the peace.

Each county or corporation shall be provided with necessary blank

forms by the clerk of the court, to be paid for out of the funds of the
aid county or corporation. The record of proceedings under this sec-
ion, together with the warrant of commitment, shall be made in dupli-
ate, one copy of which shall be delivered by the judge or justice to the
heriff or sergeant of the county or city, and the other copy filed in the
fice of the county.