In the matter of Charlotte Anderson of Middlesbrough Workhouse in the North Riding of the County of York inmate an alleged lunatic I the undersigned George Lowbotham do hereby certify as follows:
I am a person registered under the Medical Act 1858 and I am in the actual practice of the medical profession.
On the 17th day of January 1893 at Middlesbrough Workhouse in the North Riding of the County of York I personally examined the said Charlotte Anderson and came to the conclusion that she is a person of unsound mind and a proper person to be taken care of and detained under care and treatment.
I formed this conclusion on the following grounds, viz:-
Facts indicating insanity observed by myself at the time of examination, viz.:
She looks in distress of mind, suspects those around her of speaking evil of her, she is suffering from paralysis of speech and complains of her head. Says there are men in the ward annoying her. That she hears people knocking at the wall and talking to her.
Facts communicated by others:
Annie Lelancey, nurse, states that she is very excitable, frequently crys, apparently in great distress because there are men about the ward an intend to do something to her. She suspects all around her of speaking against her. Hat she tries to get out of the hospital to get away from the imaginary men.
The said Charlotte Anderson appeared to me to be in a fit condition of bodily health to be removed to an asylum.
I give this certificate having first read the section of the Act of Parliament printed below.
Signed George Lowbotham
of Carlton Lacy, Middlesbrough
Dated this 17th day of January 1893
Extract from section 317 of the Lunacy Act, 1890
Any person who makes a wilful misstatement of any material fact in any medical or other certificate, or in any statement or report of bodily or mental condition under this Act, shall be guilty of a misdemeanour.