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77
HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL.
Public Health Office: 92, Bath Road, Hounslow.
DIPHTHERIA IMMUNISATION CLINIC
This is to certify that
(Name)
(Address)....................................................................................................
was immunised and tested, and is believed to be immune to
Diphtheria.
to the parent or guardian.
In the event of this child being ill in the future and the doctor
suspects Diphtheria, please show him this certificate, when he will
tear off and use the card printed below.
Elwin H. T. Nash.
Medical Officer of Health.
This card should be retained by the parent or guardian.
(Tear off here)
: perforation .
HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL.
Public Health Office: 92, Bath Road, Hounslow.
DIPHTHERIA IMMUNISATION CLINIC
This is to certify that
(Name)
(Address)
was immunised and tested, and is believed to be immune to
Diphtheria.
Date Signed
Mvdical Officer of Immunisation Clinic.
To the
Doctor in Attendance.
If you consider this a case of definite
diphtheria, I shall be glad
if you will post this card with
your notification to the Medical
Officer of Health of the district
where the case is notified.
To the
Medical Officer of Health concerned.
If this child is definitely suffering
from diphtheria, I should be glad if
you would inform me, particularly
indicating the character of the attack
—"Mild/severe"—and enclose this
certificate with your letter.
Elwin H. T. Nash,
Medical Officer of Health.