Reception Order signed by: George Chance, Dated: April 18, 1885
Sex and Age: m 29
Civil State: Single
Occupation: Labourer
Religion: Ch. of Eng.
First Attack: No
Age on first attack: N.K.
When and where previously under treatment: Colney Hatch (crossed out)
Duration of present attack: 10 days
Supposed cause: Not known
Epileptic: No
Suicidal: No
Dangerous to others and how: Yes
Any near relative afflicted with Insanity: Not known
Union chargeable to: St. Saviours
Previous Place of Abode: 24 Barlow St., Walworth
Name and Address of Person to whom Notice of Death to be sent: Bro
Names and Addresses of one or more relatives of the Patient: J. Tuck, 11 Acre St., Beckway St., East St., Old Kent Rd.
Medical Certificate Signed by: Walter Rumboll
Facts indicating insanity observed by myself at the time of examination viz.:
He states that he is followed about by unseen persons who fix impressed air on him which causes him to suffer punishment which others ought to have. He sancies he is watched night and day by unseen persons to saddle him with a crime of which be is not guilty.
Facts communicated by others viz.:
Francis J. Gray (his landlord) states he carries a knife secreted in his clothes with which he threatens to stab people. He paces the room at night without any object as though in great trouble. He fancies the prison authorities have caused him to have small pox altho he has no spots about him. Has undergone Penal Servitude.
Transferred from: Colney Hatch
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.
Quite demented. Cannot answer the simplest question rationally. First said his age was 38 then 62. Often answers with quite unintelligible words. Has no idea of time or place.