6282-14-1 Folio 33

Name: Jonah CLARK,

Aged: 66,

Reg. No. 33,

Admitted: August 16, 1899.

Copy of Statement of Particulars

Reception Order signed by: P. M. Martineau, Dated: August 14, 1895

Sex and Age: m 62

Civil State: Married

Occupation: Lamp Maker

Religion: Ch. of Eng.

First Attack: Yes

Age on first attack: 62

When and where previously under treatment: Claybury Asylum (Crossed out)

Duration of present attack: 1 week

Supposed cause: Not known

Epileptic: No

Suicidal: No

Dangerous to others and how: No

Any near relative afflicted with Insanity: Not Known

Union chargeable to: St. George's E.

Previous Place of Abode: 50 Harding St., St. George's E.

Name and Address of Person to whom Notice of Death to be sent: As below

Names and Addresses of one or more relatives of the Patient: Jane Clark, 50 Harding St.m St. George's E.

Medical Certificate

Medical Certificate Signed by: ..Rowlan

Facts indicating insanity observed by myself at the time of examination viz.:

He states that he has been here one month wheraas he was admitted (10th just). He states he hears that he hears voices saying "What a peculiar man Clark is", He talks incoherently & sleeps very little.

Facts communicated by others viz.:

Transferred from: Claybury

Condition on Admission

Mental State:-

As far as possible under such Headings as:
Attention, Comprehension and Re-action, Cognition of self and surroundings, including mistakes of identity and appreciation of time and place, States of Stupor and Catalepsy, Memory for recent and remote events, Association and flow of ideas, Coherence, Reasoning power, Hallucinations, Illusions, Delusions, Exaltation, Fantasies of dress, Excitement, Depression, Impulses—General, Suicidal, Homicidal, Erotic, Destructive, Obsessions, Resistiveness or Hostility, Restlessness, Self-employment, Attention to personal needs, Religiosity, Sense of propriety, Lewdness of conversation and conduct, Regard for relatives.