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Charles Stoldberg's Application for Admittance to JCRS, 1908 August 22

Identifier: B002.01.0100.0046.00001


Application for admittance to JCRS filled out by hand in ink for Charles Stolberg. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, nearest relatives, and signed by Charles Stolberg "1476 Irving St.". At the bottom of the page, under "Recommendation" are two names and addresses, "A. Grossman, 2035 Champa St." and "M. Cohen, 2021 Champa St." The back of the form has section entitled "Report of Medical Examiner", which states the date, August 22 1908, and that Stolberg is in second stage of pulmonary tuberculosis, and written in ink "fragile". The middle section of the back is a form filled out by hand in ink. It reads "Application No. 878, Case No. 603, Charles Stolberg, Address 1476 - Irving St., Recieved Aug 22 1908, Accepted Aug 31 1908, Admitted Sept 2 1908, Left May 21 1909. Underneath that, handwritten in pencil, there are five lines of illegable writting. The bottom of the page reads "Admissions and Dismission Committee" which is blank.


  • 1908 August 22


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1 items (application)

Scope and Contents

From the Series: This series of patient records includes medical reports and histories, statistical data of patients, x-rays, and death certificates. The patient files include applications, correspondence and some may also contain photographs and personal items.


Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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