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Alex Vendig's Application for Admittance to JCRS, 1909 June 5

Identifier: B002.01.0101.0075.00001


Application for admittance to the JCRS filled out by hand in ink for Alex Vendig. Information on the form includes his age, birth place, occupation, residence, marital status, nearest relatives, and signed in ink by Alex Vendig. At the bottom of the page is a section, "Recommendation," is left blank except for a note that reads "Letter from Samu'l Dorf." The back of the form has a section entitled "Report of Medical Examiner" which states that the exam took place on June 7, 1909 and diagnosed Alex Vendig with second stage tuberculosis. The report notes "well advanced. lost 30 lbs, very weak, pulse 120 voice is whisper for past 2 1/2 months. Coughs great deal, raise [illegible]. Rt lung [illegible]" and is signed by "Robert L. Charles MD." The middle section of the back is a form filled out by hand in ink. It reads "Application No. 2031, Application of Alex Vendig, address 1471 Knox Ct, Received June 5 1909, Accepted June 11 1909, Admitted June 11 1909, Died June 28 1909." The bottom of the back is entitled "Admission and Dismission Committee" which has been left blank.


  • 1909 June 5


Conditions Governing Use

Copyright not evaluated: The copyright and related rights status of this Item has not been evaluated. Please refer to the organization that has made the Item available for more information. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. See:


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 form, at the top of the middle section "EMERGENCY" is stamped in blue ink. The number "1131" is stamped in black ink over the application number "2031." In the same section, the line " Left June 28 1909" is crossed out and "June 28 1909" is written on the line below titled "died."


Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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