OK, the entry is on the 1895 Workhouse Admission form for the City Road Workhouse, in Holborn. My ancestor is Francisco Dellino. He was born in 1881, and in the column 'By whose order' it reads 'Insane' Goldsmith?. He was inside from March 18th to April 3rd, when he was discharged 'To Father'. His religion is listed as RC, and his class for diet is 3? His parish is listed as C? and Goldsmith is noted again. In the column 'If born in the house, name of parent' it reads 27 S? The final column is his address, which is correct, 35 Warner St.
If anyone has any ideas on the points where I have a ? that would be great!!