The image is a scanned copy of a medical certificate of successful vaccination. The certificate is titled "Compulsory Vaccination Act. Schedule A. Medical Certificate of Successful Vaccination." 

The certificate is dated 1863 and has a signature of the person certifying the person's name, address, and other personal information. It also mentions that the person has been successfully vaccinated by me.

At the top of the certificate, there is a heading that reads "16 & 17 Victoria, Cap. 100." Below the heading, there are two lines of text that read "To be delivered pursuant to Section IV, to the Father or Mother of every Child successfully Vaccinated, or to the Person having the Care, Nurture, or Custody of such Child."

On the right side of the document, there has a section titled "The undersigned, hereby certify, that aged (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28) (29) (30) (31) (32) (33) (34) (35) (36) (37) (38) (39) (40) (41) (42) (43) (44) (45) (46) (47) (48) (50) (51) (52) (53) (54) (55) (56) (57) (58) (59) (60) (61) (62) (63) (64) (65) (66) (67) (68) (69) (70) (71) (72) (73) (74) (75) (76) (77) (78) (79) (80) (81) (82) (83) (84) (85) (86) (87) (88) (89) (90) (91) (92) (93) (94) (95) (96) (97) (98) (99) (100) (102) (103) (104) (105) (106) (107) (108) (109) (110) (112) (