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to give instructions to have this done if you will please to cause to be filled in
and signed the appended form of certificate and form of request, and return
them to me as addressed.
I am, Sir or Madam,
Your obedient Servant,
John F. J. Sykes,
Medical Officer of Health.
N.B.—This circular letter is sent to the person in charge of any case of this
disease coming to the knowledge of the Medical Officer of Health through the
death returns, or notice of removal to hospital, or elsewhere.
ST. PANCRAS BOROUGH COUNCIL.
Public Health Department.
Public Heai.tii (London) Act, 1891.
Infectious Diseases other than technically "Dangerous."
Consumption, &c.
Certificate of Medical Attendant.
This is to certify that (Christian and Surname)
(sex and age) has suffered from
(disease) , an infectious disease, at
(address)
and has recovered in or has been removed from the room situated on the
floor at the side of the house, and that I am of opinion that the
infected room and the contents ought to be properly disinfected and cleansed
to prevent the spread of infectious disease.
(Name)
Registered Medical Practitioner.
(Address)
Date
Authorisation of Occupier.
This is to authorise the Officers of the St. Pancras Borough Council to enter
the above premises and to disinfect and cleanse the parts of the house stated in
the above certificate under the conditions set out in the clauses as to dangerous
infectious diseases in the Public Health (London) Act, 1891.
(Name)
Occupier.
Date