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

Ampt. Rt. arm at shoulder joint

4. Duration, and whether active or stationary

From accident - Seven years ago

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

no

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?

Healthy in all other aspects

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 fits
no

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

no none whatsoever

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

Has had whooping cough & measles has been vaccinated

10. Is the child's general health good?

thoroughly good

Signature V
Qualifications M.D., M.R.C.S. Eng.
Address Tunbridge Wells
Date April 26th, 1890