| Street and No. | Hospital |
| Civil Parish of | The Holy Trinity |
| Municipal Borough | Dorchester |
| Town of | Dorchester |
| Local Board of | Dorchester |
| Name | Rel | Condition | Age | Sex | Occ | Birthplace |
| Susan FUDGE | Patient | Married | 38 | F | Housewife | Dorset, Sturminster Newton |
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