6282-14-1 Folio 16

Name: James TILBURY,

Aged: 69,

Reg. No. 16,

Admitted: August 15, 1899.

Copy of Statement of Particulars

Reception Order signed by: Wm. Bird, Dated: June 17, 1892

Sex and Age: m 62

Civil State: Widower

Occupation: Bricklayer

Religion: Protestant

First Attack: Yes

Age on first attack: 62

When and where previously under treatment: Colney Hatch Asylum (crossed out)

Duration of present attack: Several weeks

Supposed cause: Unknown

Epileptic: No

Suicidal: No

Dangerous to others and how: No

Any near relative afflicted with Insanity: No

Union chargeable to: Hammersmith

Previous Place of Abode: 22 Westcombe Cottages, H'smith

Name and Address of Person to whom Notice of Death to be sent: R. Shirt (friend), 12 Malvern Rd., Hornsey, N.

Names and Addresses of one or more relatives of the Patient: R. Tilbury (Son), 63 Marlboro' Rd. N, W. Kensington Pk. W.

Medical Certificate

Medical Certificate Signed by: Alderton

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

Patient has no memory, says he is 91 years of age, says he has been here over 20 years, was admitted on Tuesday, says he is not quite right in his head.

Facts communicated by others viz.:

Wm. H. Luke (Attendant) Fulham Union states patient does not seem to know what he is talking about, says no & yes to everything, wanders about night & day.

Transferred from: Colney Hatch

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.

Quarulous, demented, rambling in his statements. Shows some loss of memory; apparently has a fall and subsequently (R) hemiplegia from which he almost entirely recovered.