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Public Health

Title: Death Certificate
Type: Document
Date: 1917
Source: Minnesota Historical Society

Description: Death certificates were completed for the families of those who died of smallpox.

Transcription:

Disease                                                            58

Smallpox          NAME Marion Flynn          AGE 19          SEX f.
ADDRESS St. Marys Hosp.          DATE REPORTED 6/4/17          BY WHOM
DATE TAKEN SICK 6/3/17          DATE OF FIRST ERUPTION          DATE CARDED
CASE FIRST SEEN BY DR. Manley          ON 6/4/17          HOW LONG AT THIS ADDRESS
PREVIOUS ADDRESS                    SOURCE OF INFECTION
OCCUPATION Nurse          WHO FOR St. Mary's Hosp.          ADDRESS
NO CHILDREN ASSOCIATES          NO ADULT ASSOCIATES          MILK SUPPLY
WATER SUPPLY AT RESIDENCE                    AT PLACE OF OCCUPATION
SANITARY CONDITION OF PREMISES          SEWER CONNECTIONS Yes/No OUTSIDE TOILET Yes/No
QUARANTINGED AT Iso. Hosp.          DATE 6/4          TRANSFERRED TO          DATE
FOR SMALL POX OR CHICKEN POX,
DATE OF LAST SUCCESSFUL VACCINATION Never successfully vaccinated SCAR PRESENT Yes/No
VIRULENT/BENIGN          FILLED OUT BY          TERMINATED BY Death/Recovery ON 6/10-1917

For Names and Addresses of Persons Exposed or Similarly Affected, Use Other Side