Case 2434

St. Nicholas Home for Crippled Children,
Trinity Road, Upper Tooting.
Medical Certificate

1. Child's name

A

2. Age

11 years

3. Nature of disease

Right arm amputated at shoulder

4. Duration, and whether active or stationary

Seven years ago

5. Is the child hoplessly crippled so that it cannot be trained to earn its living?

the right arm is gone

6. Has the child any affections of the limbs, joints, skin or eyes which may have the effect of preventing it from entering domestic service?

none beyond rt. arm gone

7. Is the child subject to fits? or has it ever had one? If so, state its nature
Is the child subject to incontinence of urine?

no no

8. Is the child at present affected with any infections or contagious disease, such as ringworm, & or with scrofula, requiring medical treatment?

no

9. Has the child had scarlet fever or whooping cough, measles, or small pox? If not the later, has it been vaccinated?

vaccinated Had measles & whooping cough

10. Is the child's general health good?

yes
Signature W
Qualifications M.D.
Address Belmont Tunbridge Wells
Date April 26th, 1890