Case 9627

St. Nicholas Home for Crippled Children,
Byfleet, Near Weybridge.

Medical Certificate

1. Child's name

J

2. Age

7 years

3. Nature of Disease

Anterior Polio - myelitis

4. Duration, and whether active or stationary

Stationary from birth

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

no

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

(yes the complaint named)

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?

not since birth the fit being the precursor of the paralysis
no

8. Is the child at present affected with any infections or contagious disease, such as ringworm, &c., 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. no. measles yes no
yes has been vaccinated

10. Is the child's general health good?

yes

Signature J

Qualifications [?]

Address Newport I W

Date 5 / 5 / 03