View report page

38
METROPOLITAN ASYLUMS BOARD.
Warrant for Anti-Toxic Serum.
In Exchange for this Warrant and the subjoined
Certificate, the Bearer is entitled to receive one bottle of
Anti-toxic Serum, for use in the treatment of the Patient named
in the said Certificate, who cannot be immediately received into
one of the Board's Hospitals.
(By Order)
T. Duncombe Mann,
Clerk to the Board.
Certificate of Medical Practitioner.
To the Medical Officer of Health for
(on behalf of the Metropolitan Asylums Board.)
I hereby certify that I require one bottle of Anti-toxic
Serum for use in the treatment of
a Patient under my care residing at
, who is suffering from Diphtheria,
and who cannot immediately be received into one of the Hospitals
of the Board.
I undertake to use the Serum so supplied to me exclusively
for the treatment of the above-mentioned case, and for none other
and I further undertake to return forthwith the Serum should the
Patient (or responsible relations) object to its use.
(Signed) Name and
Address of
Medical
Practitioner.
Dated 189