London's Pulse: Medical Officer of Health reports 1848-1972

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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London

St Pancras 1905

[Report of the Medical Officer of Health for St. Pancras, London, Borough of]

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78
ST. PANCRAS BOROUGH COUNCIL.
Public Health Department.
The Voluntary Notification of Pulmonary Phthisis.

Table: Certificate of Medical Practitioner.

Certificate of Medical Practitioner.

To the Medical Officer of Health,Tou n Hall, Pancras Road, N. W.
I hereby Certify that in my opinion:—
Name in full of the Patient
Age of Patient
Sex
Full Postal Address of House of which Patient is an Inmate
If the Patient is an Inmate of a Hospital—
(a) Place from which the Patient was brought to the Hospital.
(4) Date at which Patient was so brought
Infectious Disease from which the Patient is sufferingPulmonary Phthisis (with muco-purulent discharge or infective sputum)
"Whether the case has occurred—
(a) In the private practice of the Practitioner certifying
or
(b) In his practice as Medical Officer of a Public Body or Institution; and, if so, of what Body or Institution
Dated the day of 190 .
(Signed) , Medical Practitioner.
Address of person signing