2. Says her sister lives in Chiselhurst, and she fears she is dying. She took great notice of my feet, and remarked that they were very large. Query by Commissioner—Are these delusions? Her sister does not live at Chiselhurst, and is perfectly well; my feet are not large.
3. General restlessness of manner; considers himself heavily involved in debt to many thousands of pounds, whereas his debts do not amount to a few hundreds; says he has been ruined by the Government, whereas he has only been dismissed from his appointment on account of his incapacity; and he intends prosecuting the Admiralty for £5000 damages, he having no real ground of action. (This was twice sent back for correction, the first correction being—By these statements I was satisfied that the patient was of unsound mind, and by his general conduct during examination. Finally amended as given above.)
(a)—a Justice of the Peace for ____, or His Honour the Judge of the County Court of ____, or ____ Stipendiary Magistrate for ____.
(b) Full postal address and rank, profession, or occupation.
(c) At least twenty-one.
(g) Some day within 14 days before the date of the presentation of the petition.
(h) Here state the connection or relationship with the patient.
(k) Full Christian and surname.
53 Vict. c. 5.—Sched. 2, Form 1.