Reception Order signed by: John Willson, Dated: August 9, 1894
Sex and Age: m 65
Civil State: Married
Occupation: None
Religion: Roman Catholic
First Attack: Yes
Age on first attack: 65
When and where previously under treatment: Claybury Asylum (Crossed out)
Duration of present attack: 2 months
Supposed cause: Unknown
Epileptic: No
Suicidal: No
Dangerous to others and how: Yes
Any near relative afflicted with Insanity: No
Union chargeable to: Camberwell
Previous Place of Abode: 20 Naylor Rd. Peckham
Name and Address of Person to whom Notice of Death to be sent: Mary Canty (wife) 84 Naylor Rd., Peckham
Names and Addresses of one or more relatives of the Patient: Son, Thos. Canty, 36 Shard Rd., Peckham
Medical Certificate Signed by: Herbert Chabot
Facts indicating insanity observed by myself at the time of examination viz.:
He has a delusion that he is watched by body catchers who are waiting an opportunity to take his wife away & to get into his bedroom to kill him. He goes about prepared as it is better to kill than be killed. He also states that people are continually going in & out of the house where he was & use it as a brothel.
Facts communicated by others viz.:
His daughter, Ellen Pelty, states that goes about with his pockets filled with stones & carried a chopper. Also that his ideas about the house & property are delusions.
Transferred from: Claybury
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.