6282-14-1 Folio 26

Name: David JARVIS,

Aged: 24,

Reg. No. 26,

Admitted: August 16, 1899.

Copy of Statement of Particulars

Reception Order signed by: Douglas Gordon, Dated: August 29, 1896

Sex and Age: m 21

Civil State: Single

Occupation: Laundryman

Religion: Protestant

First Attack: No

Age on first attack: 20

When and where previously under treatment: Wandsworth Union

Duration of present attack: ?

Supposed cause: Unknown

Epileptic: No

Suicidal: No

Dangerous to others and how: No

Any near relative afflicted with Insanity: An Aunt

Union chargeable to: Chelsea

Previous Place of Abode: Chelsea Workhouse

Name and Address of Person to whom Notice of Death to be sent: Mother, Mrs. Jarvis, 41 Peach St., Queens Pk., W.

Names and Addresses of one or more relatives of the Patient: Sister, Grace Jarvis, 10 All Saints Rd., Westbourne Pk., W.

Medical Certificate

Medical Certificate Signed by: …ance

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

That he is very depressed bursting into tears on the slightest occasion says that he hears voices though he cannot see the person speaking & has delusions that some woman is running after him in order to worry him.

Facts communicated by others viz.:

John Bowke (Attendant) Chelsea Workhouse tells me that the said David Jarvis sits about in a listless state taking no interest in his surrounding if spoken to bursts into tears.

Transferred from: Claybury Asylum

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.