And it is further agreed, that the committee of visitors to superintend the building, erection, and management of the said county lunatic asylum shall be formed in the following proportion: the justices of the peace for the said county of shall the justices of the peace for the borough of and the subscribers to the said appoint shall appoint lunatic asylum of we, the undersigned, being the major part of each of the committees of justices of the peace for the said several counties and boroughs, and the major part of the committee of subscribers to the said lunatic asylum, do, on the part and behalf of the said counties and boroughs and lunatic asylum, set our hands and seals, this day of in the year shall appoint - And hereunto SCHEDULE (B.)1 FORM OF MORTGAGE and CHARGE upon the county or borough rates for securing the money borrowed.1 We, the chairman of the court of quarter sessions of the peace of the county of day of and two other of Her Majesty's justices of the peace for the said county, assembled in the said court, [or we, the mayor and council of the borough of as the case shall be,] in pursuance of the powers to us given by an Act passed in the year of the reign of Her Majesty Queen Victoria, intituled “An Act” [here insert the title of this Act], do hereby mortgage and charge all the rates and funds to be raised and paid within the said county [or borough, as the case may be], under the description of county rates or borough fund or rates, with the payment of the sum of which of hath advanced and paid towards defraying the expenses of purchasing lands, and for building and repairing, &c. [as the case shall be] a lunatic asylum for the said county [or borough, or the united counties and boroughs of, &c. as the case may be], and we do hereby grant and confirm the same rates and funds unto the said his executors, administrators, and assigns, for securing the repayment of the said sum of and interest for the same after the rate of do order the treasurer for such 1 See sect. 34, ante, p. 148. The form of charge agrees with that given in 9 G. 4, c. 40. sched. per centum per annum, and county, &c. [or borough, &c., as 2 Quære what is meant by these words with reference to a county. the case shall be,] to pay the interest of the said sum of half-yearly, as the same shall become due, until the principal shall be discharged, at the times and in the manner agreed upon between the said and the said justices [or the said mayor and council, as the case may be], pursuant to the directions of the said Act.1 SCHEDULE (C.)2 No. 1. NAMES of all PAUPER LUNATICS in the ASYLUM at for the county or borough or counties or boroughs of on the 184-. day of NAMES of all PRIVATE LUNATICS in the ASYLUM for the county or borough or counties and boroughs of on the day of 184-. SCHEDULE (D.)1 FORM OF ANNUAL RETURN. union A TRUE LIST of all LUNATICS and IDIOTS, chargeable to the parishes comprised within [such part of] the [as is situate] [or to the parish of ] in the county of specifying the names, sex, and age of each, and whether dangerous or otherwise, and for what length of time they have been supposed to be of unsound mind, and where confined, or how otherwise disposed of. Clerk to the board of guardians of the said union, 1 See sect. 47, ante, p. 158. This corresponds with the form given in the schedule No. 4, to 9 G. 4, c. 40, and 5 & 6 Vict. c. 57. SCHEDULE (E) No. 1.1 ORDER FOR THE RECEPTION OF A PAUPER PATIENT. I, C. D. [in the case of a justice of the peace, or in the case of a clergyman and relieving officer, &c., we], the undersigned, having called to my [or our] assistance a physician [or surgeon or apothecary, as the case may be], and having personally examined A. B., a pauper, and I, C. D. [or we, in the case of a clergyman and relieving officer, &c.,] being satisfied that the said A. B. is a lunatic [or an insane person, or an idiot, or a person of unsound or imbecile2 mind], and a proper person to be confined, I, [or we, as the case may be,] hereby direct you to receive the said A. B. as a patient into your asylum, hospital, or house. Subjoined is a statement respecting the said A. B. (Signed) (C. D.) * A justice of the peace for the city or borough of [or an or the * In the case of a lunatic not chargeable,3 to be signed by two justices. STATEMENT. Name of patient, and christian name at length. Sex and age. Married, single, or widowed. Condition of life, and previous occupation (if any). 1 See sects. 48, 49, and 51, ante. This corresponds with the form of the warrant given in schedule No. 5, to 9 G. 4, c. 40. In the notes upon those sections will be seen the variations between this form and that in the 8 & 9 Vict. c. 100, applicable to licensed houses and hospitals. 2 This word has been retained from the original draft of the bill inadvertently. 3 i. e. under sect. 49. Previous place of abode. Age (if known) on first attack. Whether subject to epilepsy. Whether suicidal or dangerous to others. I certify that to the best of my knowledge the above par- Dated the and To (Signed) [To be signed by the relieving officer or overseer.]1 day of one thousand eight hundred superintendant of the asylum for the county of or the lunatic hospital of licensed house of house.] or proprietor of the [describing the asylum, hospital, or FORM OF MEDICAL CERTIFICATE IN THE CASE OF PAUPER PATIENTS.2 I, being a fellow [or licentiate] of the royal college of physicians in London, [or a graduate in medicine of the university of &c., or a member of the royal college of surgeons in London, or an apothecary duly authorized to practise by the Apothecaries' Company in London,] hereby certify that I have this day personally examined A. B., the person named in the accompanying statement and order, and that the said A. B. is a lunatic [or an insane person, or an idiot, or a person of unsound or imbecile mind], and a proper person to be confined. 3 |