Reception Order signed by: Wynne E. Baxter, Dated: August 17, 1893
Sex and Age: m 63
Civil State: Widowed
Occupation: Labourer
Religion: Roman Catholic
First Attack: N.K.
Age on first attack: N.K.
When and where previously under treatment: Claybury Asylum (Crossed out)
Duration of present attack: 1 week
Supposed cause: Unknown
Epileptic: No
Suicidal: No
Dangerous to others and how: No
Any near relative afflicted with Insanity: Not known
Union chargeable to: Poplar
Previous Place of Abode: 4 Hagood St., Bromley
Name and Address of Person to whom Notice of Death to be sent: J. Lynch (Son), 207 High St., Poplar, E.
Names and Addresses of one or more relatives of the Patient: As below
Medical Certificate Signed by: Lightburne
Facts indicating insanity observed by myself at the time of examination viz.:
He says that an attack of Syphilis has destroyed his kidneys, affected his head & caused his nose to be diseased, all of which are delusions.
Facts communicated by others viz.:
Alice James (Landlady) says he called in two policemen to protect him against 2 men who were about to murder him with a knife. Sometime ago he had collected several bricks in the St & was praying 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.
He is garrulous rambling & delusional. Says he was put into an asylum through an injury to his testicle & has been fearfully ill treated since they gave him stuff to drink which ran through his body & down his legs & caused a corn to form in his foot.