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Jacob Katz's Application for Admittance to JCRS, 1909 May 10

Identifier: B002.01.0101.0058.00001


Application for admittance to JCRS filled out by hand in ink for Jacob Katz. Information on the form includes his age, place of birth, occupation, residence, marital status, children's ages, nearest relatives, and signed in black ink by Jacob Katz. At the bottom of the page, under "Recommendation" are two names and addresses. The first reads "Louis Schapiro, 2709 W. Colfax," and the second reads "Max B. Goldberg, 2640 West Colfax." The back of the form has section entitled "Report of Medical Examiner," which states that the examination was done May 12, 1909 and is signed by Robert L. Charles MD. Exam reports "temp normal, pulse 120" at 11:30 am and "spat small amount of blood several months ago; night sweats [illegible] two weeks ago, voice - whisper for past over 4 months, quite emaciated (does not know much weight lost)." The middle section of the back is a form filled out by hand in ink. It reads "Application No. 2005, Case No. 777, Application of Jacob Katz, Address 1495 Decantur St., Received May 10 1909, Accepted June 21 1909, Admitted June 26 1909, Discharge August 19 1909." The bottom of the page reads "Admission and Dismission Committee" which is blank.


  • 1909 May 10


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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.

Physical Characteristics and Technical Requirements

On the back of the application, in the middle section "Application No. 2005" is stamped over with "1105" in black ink.


Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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