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DEATH
CERTIFICATE
WILLIAM SMITH
Date 31 October 1927
Cert: 22529
Place of Death: Voting Pct.: Asylum, Eastern State
Hospital, Lexington, Fayette Co., Ky.
Full Name: William SMITH
Residence: Eastern State Hospital
Length of Residence in city where death occurred: 00
years, 01 months, 17 days
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: Single
Date of Birth: 1882
Age: 45 years, + months
Occupation: Coal Miner
Birthplace: Knott Co., Ky.
Father Name: John J. SMITH
Birthplace Father: unknown
Mother Maiden Name: unknown
Birthplace Mother: unknown
Informant/Address: Records, Eastern State
Hospital, Lexington, Ky.
Filed: 02 November 1927
Registrar: D. A. Furlong
Death of Date: 31 October 1927
I hereby certify that I attended deceased from 12 September
1927 to
31 October 1927, that I last saw him alive on 31 October 1927,
and that death occurred on the date stated above at 1 p.m.
Cause of Death: Acute nephritis
Duration: 03 weeks
Contributory: Manic depressive psychosis, manic type
Duration: 03 months, 04 days
Where was disease contracted if not at place of death?:
(blank)
Did an operation precede death: no Date: (blank)
Was there an autopsy: no
What test confirmed diagnosis: usual
Signed/Address: W. R. Thompson, M.D., 31 October 1927,
Eastern State Hospital, Lexington, Ky.
Place of Burial or Removal: Kragon, Ky.
Date of Burial: 03 November 1927
Undertaker/Address: Wiehl, Lex., Ky.
Transcribed by Debbie Tamborski, 23 March 2010 |
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