6282-14-1 Folio 21

Name: William Joseph MOORE,

Aged: 59,

Reg. No. 21,

Admitted: August 15, 1899.

Copy of Statement of Particulars

Reception Order signed by: Charles Horsley, Dated: September 24, 1897

Sex and Age: m 47

Civil State: Married

Occupation: Gold Wire Drawer

Religion: Ch. of Eng.

First Attack: No

Age on first attack: 46

When and where previously under treatment: 1836 Banstead, Colney Hatch (crossed out)

Duration of present attack: 14 days

Supposed cause: Unknown

Epileptic: No

Suicidal: No

Dangerous to others and how: No

Any near relative afflicted with Insanity: Unknown

Union chargeable to: Islington

Previous Place of Abode: 109 Andover Rd. N.

Name and Address of Person to whom Notice of Death to be sent: Wife, S. Moore, 59 George's Rd., Holloway

Names and Addresses of one or more relatives of the Patient: Son, J. Moore, 26 Barnard Place, Eden Grove, Holloway

Medical Certificate

Medical Certificate Signed by: Gray

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

Imagines three men dressed as women follow him about to throw pertrol over him. Says he can hear them but not see them that they have done so for a long time & that his clothes & skin are much burnt (such is not the case) thinks electric fluid is in the floor & that it collects on his brain in a load.

Facts communicated by others viz.:

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.