6282-14-1 Folio 28

Name: Charles BURKE,

Aged: 51,

Reg. No. 28,

Admitted: August 16, 1899.

Copy of Statement of Particulars

Reception Order signed by: Charles Collambell, Dated: February 25, 1886

Sex and Age: m 38

Civil State: Married

Occupation: Potman

Religion: Ch. of Eng.

First Attack: Yes

Age on first attack: 38

When and where previously under treatment: Claybury Asylum (Crossed out)

Duration of present attack: 6 months

Supposed cause: Unknown

Epileptic: No

Suicidal: No

Dangerous to others and how: No

Any near relative afflicted with Insanity: Unknown

Union chargeable to: Lambeth

Previous Place of Abode: 4 Cornwall Rd. Lambeth

Name and Address of Person to whom Notice of Death to be sent: As below

Names and Addresses of one or more relatives of the Patient: Mrs. E. Burke, 46 Ridley Road., Kingsland, N.E.

Medical Certificate

Medical Certificate Signed by: …vis Rugg

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

Says that he has been persecuted & has hadhis nose taken off which has prevented him getting any work. Says people talk to him but he does not know who they are. Complains of giddiness in his head. Talks nonsense such as his left nose is off & he was told to come here for a kiss. Seems very excitable.

Facts communicated by others viz.:

Attendant Eilbeck states that the patient is restless, mutters to himself, breaks out into fits of crying & sudden passions without any apparent cause.

Transferred from: Claybury

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.