6282-14-1 Folio 44
Name: Charles CHALLIS,
Aged: 33,
Reg. No. 44,
Admitted: August 16, 1899.
Copy of Statement of Particulars
Reception Order signed by: Jno. F. Jones, Dated: June 8, 1898
Sex and Age: m 32
Civil State: Single
Occupation: Labourer
Religion: Ch. of Eng.
First Attack: No
Age on first attack: N.K.
When and where previously under treatment: Claybury Asylum
Duration of present attack: few days
Supposed cause: Unknown
Epileptic: No
Suicidal: No
Dangerous to others and how: No
Any near relative afflicted with Insanity: Not known
Union chargeable to: Hackney
Previous Place of Abode: Hackney Infirmary
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. Cole, 64 Rainsmore Rd., Page Green, Tottenham
Medical Certificate
Medical Certificate Signed by: Gordon
Facts indicating insanity observed by myself at the time of examination viz.:
He is very depressed & tired of his life, says he will drown himself in the River Lea if he is not taken care of, imagines he is followed about by two men.
Facts communicated by others viz.:
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.
He is silly & childish in manner. Says he is wrong in his head & hears noises in his ears like a lot of wasps. Says the year is 999.