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GENERAL AFFIDAVIT State of Tennessee, County of Campbell, SS: In the matter of claim for pension No 1038.457 of B. F. Smith,
Guardian of Brice M. Smith. He further declare that he has no interest in said case, and is not concerned in its prosecution. 1. -------------------------------} 2.--------------------------------} { Lee J. Smith Signature of Affiant. No Witness signed Attention is invited to the outlines of the human skeleton and figure upon the back of this certification, and they should be used whenever it is possible to indicate precisely the location of a disease or injury, the entrance and exit of a missile, an amputation, &c. The absence of a member from a session of a board and the reason therefore, if known, and the name of the absentee, must be indorsed upon each certificate. Insert character Cause of Disability Here give the claimant's statement as briefly and as compactly
as possible. Upon the examination, we find the following objective conditions:
Pulse rate, 80 From examinations of attendants, we learn that in the last two years, claimant has had melancholia prior to that time was dangerous when annoyed. We find no physical signs suggesting the cause of melancholia. Claimant states that just before enlisted was thrown from a horse and struck on back of head and was Adead @ for 15 or 20 minutes. We find no scars on head. Imagines sometimes he is someone else. Loses his identity. We do not believe there is any illusions now nor any suicidal tendency. This claimants bodily conditions do not present him from performing any manual labor, but his mental condition is such as to require the constant aid and regular attendance of another person. He is, in our opinion, entitled to a 1st grade rating for the disability caused by Insanity for that caused by ------------------------------------------------------------, and --------------------------- for that caused by ----------------------------------------------------------- -----------------------------, Pres. --------------------------, Sec'y ---------------------------------, Treas. Use this blank for a Certificate made SURGEON'S CERTIFICATE Applicant for Original ----------------------------------, Pres., L. J. Price, Sec'y, } BOARD Post Office, Knoxville P.S.-Write your Post-office address plainly and
in full. (On bottom, handwritten) State of Tennessee Brice M. Smith was of Co. C, 9th Regt Tenn Cav. Personally appeared before me, the undersigned authority duly authorized commissioned and sworn in and for said County and State, B. F. Smith, who after being sworn deposes as follows: That he is a brother of said, Brice M. Smith, and that he knows the said, B. M. Smith, was in Co. C, 9th Regt Tenn Cav. and that he came home out of the service complaining of his head and continued to complain for sometime in the year of 1867, when he went crazy and was taken and confined in the Insane Asylum at Knoxville, Tennessee, where he remained for about 5 or 6 months. Then he was brought back home, and about, Aug 2, 1872, said, B. M. Smith and Francis Lasley were married. The fruit of this marriage was as followed, 1st one son, Jordan Smith, born, August 1873, Martha Smith, born, April 28, 1876, Arch Smith, was born, Sept 22, 1878. Luther Smith, was born, Sept 15, 1881. Luther Smith, died, Nov 20, 1881. Francis, wife of B. M. Smith, died, Jan 6, 1882. This the said Affiant certifies as from the family record, and knows the children to be the said, B. M. Smith's. Things moved on quietly for a while, when sometime in the year 1883, said, B. M. Smith, went crazy again and was taken to the Insane Asylum at Knoxville, Tenn, where he has remained ever since, and the Drs. who have charge of said Asylum, say his disease is incurable, and that the said, B. M. Smith, will never be able to be turned out at large again. These facts are personally known to affiant from having lived near said, B. M. Smith. All the while the ?????, his brother was brought in direct contact with the case. The 3 living children of B. M. Smith is now and has been for several years, at the house of the said, B. F. Smith's, where he has been caring for them. And that he is the identical, B. F. Smith, he represents himself as said declaration to be. B. F. (X) Smith (Guardian) State of Tennessee Sworn to and subscribed before me the 28th Feb. 1891, and I certify that I have no interest, in this claim and that this written affidavit was read over and fully understood by affiant before signing the same and that affiant is a reputable person and entitled to full credit. F. P. McNew State of Tennessee Personally appeared before me, the undersigned authority duly authorized to administer oaths, W. Allen Marlow, of lawful age, whose post office address is Wellspring, Tenn, and James Chadwell, whose post office address is the same, both after being sworn deposes as follows: That they were acquainted with said, B. F. Smith, and Brice M. Smith, before the war, and that they know that said, B. M. Smith, was a member of Co. C, 9th Regt Tenn Cav. and that sometime during the war, he was sick at Knoxville, Tenn, it might be measles and always before that, he did not seem to be right when in a few years after the war, say, sometime in 1867, said, B. M. Smith, went crazy and was sent to the Insane Asylum, where he remained for sometime. He then came back home and was later married to Francis Lasley, and now, B. F. Smith, has the 3 children of B. M. Smith's, Jordan, Martha, and Arch Smith. Said, B. M. Smith's wife died sometime in 1882 or 1883, and in about a year, said, B. M. Smith, went crazy and was taken to the Insane Asylum, where he has remained ever since, and where he now is. The above facts are personally known to Affiants from having known B. M. Smith and B. F. Smith, both before and since the war, and know them to be brothers and that the said, B. M. Smith was a member of Co. C, 9 th Regt Tenn Cav., from the said fruits both having served in said, Co. C, 9 th Regt Tenn Cav. The Affiants knows that the said, B. M. Smith, is the identical man he represents himself to be. And the facts stated are true to the best of his knowledge and belief and that they have ever since he was and for sometime before lived ??? an average of about 5 to 9 miles of the said, B. F. Smith, and B. M. Smith, until he went crazy and have frequently live in this home. That they are in no wise interested in said cause for pension. William A. (X) Marlow Attest: State of Tennessee Personally appeared before me, the undersigned authority duly authorized and commissioned authority, Lee J. Smith, of lawful age, a resident of Stockville, Campbell County, Tenn, and Charley Boyd, of lawful age and a resident of Stockville. Tenn., both having been duty sworn according to law, deposes as follows: And says that they were both well acquainted with Brice M. And B. F. Smith, before the war, and have known B. M. Smith, since he was know that he went crazy in a short time after the war and was sent to the Insane Asylum, where he remained for sometime and then he came home and sometime in about 1872 was married to, Francis Lasley, and the fruits of this marriage was 4 children, 3 now living, namely, Jordan, Martha and Arch Smith. All of which make their home with B. F. Smith, where he is caring for them. And that the said, B. M. Smith left no means of support for said children and that sometime in about 1881 or 1882, his wife died and in about a year thereafter, he again, went crazy ans was taken to Knoxville, Tenn and placed in the Insane Asylum where he has been ever since and is now. And that the said, B. F. Smith, has been caring for the children, and that he has taken then to his house, where they make their home. That the above facts are personally known by addiants from having lived within 2 to 1 mile of said claimant. And they know him to be the identical B. F. Smith, he represents himself to be and that he is in no wise interested in said claim for pension, and that the above facts are personally know to affiants Lee J. Smith (signature signed) Attest: State of Tennessee Sworn to and Subscribed before me, this 28th day of Feb. 1891, and I certify that I have no interest in this claim and that the foregoing affidavit was read over and fully understood by affiants before Signing and that affiants are reputable persons and entitled to credit C F. P. McNew
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