Folio 05

Name: Wiliam John Innes,

Aged: 23,

Reg. No. 5,

Admitted: August 15, 1899.

Copy of Statement of Particulars

Reception Order signed by: Alexander Ritchie, Dated: August 25, 1893

Sex and Age: m 17

Civil State: Single

Occupation: None

Religion: Wesleyan

First Attack: No

Age on first attack: 14

When and where previously under treatment: Colney Hatch Asylum (Crossed out)

Duration of present attack: 3 years

Supposed cause: Unknown

Epileptic: No

Suicidal: Yes

Dangerous to others and how: Yes

Any near relative afflicted with Insanity: No

Union chargeable to: Lambeth

Previous Place of Abode: 10 Champion Place, S.W.

Name and Address of Person to whom Notice of Death to be sent: Mother (as below)

Names and Addresses of one or more relatives of the Patient: Sarah Innes, 9 Champion Place, Upper Tulse Hill

Medical Certificate

Medical Certificate Signed by: Blackford

Facts indicating insanity observed by myself at the time of examination viz.:

Patient states that he has irresistible impulses. Does not remember the day, month, or year, is strange in his manner.

Facts communicated by others viz.:

Henry Elliot (Attendant) Lambeth Infirmary states that the patient is restless, strange, mutters to himself. Sates that at times he has impulses to injure people. Uses bad language without provocation, and says he cannot help it.

Transferred from: Colney Hatch

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.

Is rambling & incoherent in conversation. Suffers from hallucinations. Says he is kept awake at night by electric batteries, that lights from the other side of the room are continually playing all over him. Admits self abuse.