Reception Order signed by: Sydney Lloyd Smith, Dated: December 16, 1895
Sex and Age: m 38
Civil State: Married
Occupation: Clerk
Religion: Protestant
First Attack: Yes
Age on first attack: 34
When and where previously under treatment: Claybury Asylum (Crossed out)
Duration of present attack: 2 weeks
Supposed cause: Unknown
Epileptic: No
Suicidal: No
Dangerous to others and how: No
Any near relative afflicted with Insanity: No
Union chargeable to: Lambeth
Previous Place of Abode: 35 Regents Square
Name and Address of Person to whom Notice of Death to be sent: Wife (as below)
Names and Addresses of one or more relatives of the Patient: Mrs W. Scott, 87 Selkirk Road, Lower Tooting, S.W.
Medical Certificate Signed by: Thomas Scott
Facts indicating insanity observed by myself at the time of examination viz.:
He states that a medium controlled his actions, that he should rely on the medium for the support of his wife and family, he recognised the medium only as a voice & if the voice suggested murder or suicide to him he should be bound to do it.
Facts communicated by others viz.:
Clara Scott, (wife) states that her husband told her the voice of a medium told him to leave his situation which he did & that he could not live with her any longer as the medium had ordered him to leave her. He has twice threatened to cut her throat & has ceased to take any notice of the children, previously he was very kind & affectionate to them.
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.
Is delusional. Hears communications, a sort of natural telegraphy, which affects him. Says he used to hear voices telling him to do things. A voice told him to leave his house, so he did so. Has felt electricity acting on his head numbing the senses.