| From No. | Phth |
| No. | 183 |
| Name | Mayersbach, Ar.E. |
| Year Born | 1872 |
| Condition | M |
| Calling | Painter |
| By whose order admitted | Scott |
| No. of Ward | 4 |
| Name and Address of nearest known Relative or Friend | Wife Annie ?/a |
| From whence admitted | 76 Gloucester Rd |
| Remarks | |
| Date of Admission | 5.5.11 |
| Date of Discharge | 12.5.11 O.R. |
| Date of Admission | 2.6.11 |
| Date of Discharge | Hanwell Asylum 10.6.11 |
Source: Ancestry.com. London, England, Workhouse Admission and Discharge Records, 1659-1930 Reference Number: STPBG/280