Folio 38

Name: Charles Henry SHEARMAN,

Aged: 57,

Reg. No. 38,

Admitted: August 16, 1899.

Copy of Statement of Particulars

Reception Order signed by: R. Benson, Dated: February 19, 1876

Sex and Age: m 34

Civil State: Single

Occupation: Assistant Secretary

Religion: Ch. of Eng.

First Attack: No

Age on first attack: 23

When and where previously under treatment: Bethlem Hospital, Brookwood

Duration of present attack: 2 years

Supposed cause: Unknown

Epileptic: No

Suicidal: No

Dangerous to others and how: No

Any near relative afflicted with Insanity: Unknown

Union chargeable to: St. George's W.

Previous Place of Abode: 9 lambeth Rd., S.E.

Name and Address of Person to whom Notice of Death to be sent: As below

Names and Addresses of one or more relatives of the Patient: James E. Shearman, 44 Marle Lane

Medical Certificate

Medical Certificate Signed by: Donahoo

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

He told me he was a confessor & an archbishop, a martyr & that King Charles pays for his tobacco, and he got his degree from the clouds.

Facts communicated by others viz.:

Henry George Slade says he goes on in an extravagent manner about religious matters.

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.