Reception Order signed by: Thomas Haymes, Dated: August 15, 1899
Sex and Age: m 15
Civil State: Single
Occupation: None
Religion: Roman Catholic
First Attack: Yes
Age on first attack: 15
When and where previously under treatment: Colney Hatch (crossed out)
Duration of present attack: 6 weeks
Supposed cause: Injured his head falling from a swing 5 years ago
Epileptic: No
Suicidal: No
Dangerous to others and how: No
Any near relative afflicted with Insanity: No
Union chargeable to: St. Saviours
Previous Place of Abode: Newington Workhouse
Name and Address of Person to whom Notice of Death to be sent: M. Beston - Father, Camberwell Workhouse, Gordon Rd.
Names and Addresses of one or more relatives of the Patient: G. Beston, Bro: Gordon House, Gordon Rd.
Medical Certificate Signed by: Williams
Facts indicating insanity observed by myself at the time of examination viz.:
He is dull & stupid, sits in an apathetic way taking little notice of what is going on. He says that everyone calls him silly. He does not known the date of the month nor does he know much of figures nor can he accurately tell the time.
Facts communicated by others viz.:
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.
His expression is vacant & he is childish & weak minded. Is nervous & says that he has fits when frightened that someone will do him damage. Cannot tell year or month says this is January.