6282-14-1 Folio 31
Name: William COUSINS,
Aged: 46,
Reg. No. 31,
Admitted: August 16, 1899.
Copy of Statement of Particulars
Reception Order signed by: H. J. Bushby, Dated: March 19, 1887
Sex and Age: m 34
Civil State: Single
Occupation: Wood Turner
Religion: Ch. of Eng.
First Attack: Yes
Age on first attack: 34
When and where previously under treatment: Claybury Asylum (Crossed out)
Duration of present attack: 1 month
Supposed cause: Unknown
Epileptic: No
Suicidal: No
Dangerous to others and how: Yes
Any near relative afflicted with Insanity: Unknown
Union chargeable to: Shoreditch
Previous Place of Abode: 14 Maidstone St. Haggerstone
Name and Address of Person to whom Notice of Death to be sent: Sister (as below)
Names and Addresses of one or more relatives of the Patient: Mrs. E. Woodland, 17 Marion Square, Pritchard Rd., Hackney
Medical Certificate
Medical Certificate Signed by: R. Immam & Forbes
Facts indicating insanity observed by myself at the time of examination viz.:
Dr Immam, He says that people come to him at night & cover him with red ochre & burn him with hot pokers. He told me there was one in the cupboard with a bullseye lantern, restless & excitable. Charles Judd says that he refuses his food saying it is made of urine & that the medicine is poison, that he says that people are under the bed with red hot pokers.
Facts communicated by others viz.:
Dr. Forbes, His memory is defective, he is destructive & dangerous, he talks in an incoherent manner, fancies people are trying to harm him with red hot pokers. Charles Judd, he refuses his food, he says all he has had to eat & drink has been mixed wine. His Brother-in-law Robt. Woodland states that he attempted to murder his sister.
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.