|
Pg. # |
Line # |
Name |
City & Co. |
Inmate of Institution |
Disease |
Duration of present attack |
Number of attacks |
Age 1st attack occurred |
Usually under lock and key |
Restrained |
Inmate of hospital or asylum
insane? |
Length of time in such place? |
Discharge |
Epileptic |
Suicidal |
Homicidal |