Case 8650

Bradstock Lockett Home for Crippled Children Southport
Medical Certificate

1. Child's Name

A

2. Age

9 yrs.

3. Nature of disease

amputation rt. leg

4. Duration, and whether active or stationary

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

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

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

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 latter, has it been vaccinated?

no

10. Is the child's general health good?

yes

Signature M
Qualifications M.R.C.S.
Address The Sheffield Royal Hospital
Date Dec. 4th 1901