STATE OF KENTUCKY } [none shown]
County of Lyon
Versus } Lunatic
This day J S Hodges Attorney for the Commonwealth filed an information as follows, to-wit: To T P Gray Judge of the Lyon County Court: I am reliably informed that _____ is a person of unsound mind and a _____ (Lunatic or Idiot) and therefore ask that a Jury be impaneled to pass upon the subject.
Attorney _____ Court
Ordered by the Court, That _____ Esq an Attorney of this Court be and he is hereby appointed to defend for and on behalf of the person under trial.
To inquire, etc., comes a Jury, to-wit: W H Marshall, Ernest Freeman, Mike Stol??, ??? Farless, Foy Williams, W?? Stovall, U Roy Oh??, Frank Scott, John Co??, John Calhoun, R S Williamson and D B Fl??.
Who being duly impaneled and sworn according to law, after hearing the evidence returned the following verdict, viz: We of the jury find from the evidence that Charley Brooks is a person of unsound mind and a _____; That the unsoundness of mind has existed since for about a year; that _he was born in Kentucky (State or Country) and resides in Lyon County and is 94 years of age; that _he was not brought into this State for the purpose of becoming a charge upon the Commonwealth; that _he owns _____ no estate of any kind; that _____ father is X and mother is _____ and reside in _____ and ha_ not estate _____ sufficient to support the person under trial; and said X is not capable of laboring either in whole or in part for _____ support.
(Additional facts as per instructions of presiding judge.)
We the jury find this man not crazy.
W A Stovall Foreman
Brief History of Case by the Presiding Judge:
Age? 94; Color? Black; Sex: Male ; Married, Single or Widowed? _____
Occupation? _____; Occupation of Husband? _____ Habits? _____
Extent of Education ? _____; Number and date of previous attacks? _____
What relatives, if any, have been insane, peculiar or intemperate? _____;
Duration of present attack: _____; How exhibited and has it changed in character _____;
Supposed cause? _____; Any delusions or hallucinations, and if so, what? _____; Subject to fits? _____; , if so, how long and from what cause: _____
Natural temper and disposition toward relatives: _____; Any threat, attempt of tendency to injure self or others? _____; Violent? _____; Destructive? _____; Cleanly? _____; Periodic frenzy and lucid intervals and duration of each: _____; What restraints have been imposed and what treatment used: _____;
Any injury about the head ever received? _____; Any bodily disease from suppression of evacuations, eruptions, sores or injuries? _____; What estate have the parents, husband or wife of the person under trial? _____;
“Together with whatever else may be deemed material toward enabling the superintendent of the asylum to understand the case.”
Wherefore it is adjudged by the Court that said X is a person of unsound mind and a X; (Lunatic or dangerous Idiot); it is ordered that _he be committed to the asylum for the insane at X Ky., and that the superintendent of said asylum be immediately notified and directed to send for said lunatic
_____ Judge _____ Court
Attest: _____ Clerk _____ Court
Term _____ Date: _____
Book No. _____ Page _____