Town of Winthrop : Record of Deaths 1910-1912, Part 1

Author: Winthrop (Mass.)
Publication date: 1910
Publisher:
Number of Pages: 956


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 1


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org.


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95


அதற்க்கா


ஆர்பிரித்


٢٧


பாட வி ழ்த்விழி - மதுரை


ـيب


J. L. FAIRBANKS & CO. Stationers


COMMONWEALTH OF M


RETURN OF A


FULL NAME


Place of


Death *


14 Coral ana


Residence


manchot


STATISTICAL DETAILS


SEX


Male


COLOR


2hete


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME +


HUSBAND'S NAME t


BIRTHPLACE # Parklar.5 Una


NAME OF FATHER


Robert Sece


BIRTHPLACE OF FATHER $


MAIDEN NAME OF MOTHER Elizabet Hyma


BIRTHPLACE OF MOTHER $


OCCUPATION


INFORMANT § wife


PLACE OF BURIAL OR REMOVAL II


DATE OF BURIAL


1980


UNDERTAKER ara Berenan-


ADDRESS Na


1910-11-12 id ....


ays


=


.190. I HEREBY CERTIFY that I attended deceased during last illness, from .............. 190. ..... to .... that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Carthereis of Liver


Sincertain . (DURATION). .... DAYS


Contributory :


Quito nephritis


(DURATION) . ... .. DAYS


(Signed) Ahl Porter M.D.


190.Q .. (Address) ..


Mainetrop


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


How long at Place of Death ? years.


months. ..................... days


Where was disease contracted, If not at place of death ?


Filed


190


Clerk


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give Its NAME Instead of street and number.


t In case of married or divorced woman, or widow. # State or country; also clty, town or county, If known.


§ Name and address of person giving statistical details. Il Name of cemetery.


FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL


....


1 Peter Bill Jan1- 1910.


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


FULL NAME


2 12202


Registered No. 100


Place of Death *


163 Blequant It Hicimos


Date of Death


Jan 9- 1910


Age


87 years.


10


.months 20 days


STATISTICAL DETAILS


SEX


COLOR


Female WE


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME t Lydia i. Balduin.


HUSBAND'S NAME t Harvie toumminge


BIRTHPLACE #


Sent RY.


NAME OF FATHER James Baldwin


BIRTHPLACE


OF FATHER#


MAIDEN NAME


OF MOTHER


BIRTHPLACE OF MOTHER # Sent. n.Y.


OCCUPATION


INFORMANT §


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from Jan 1960 ... to .... 190 ...... , that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :


Primary :


Bronchitis


Chronie


(DURATION)


DAY8


Contributory :


Age - Heach


(DURATION).


. DAYS


(Signed)


M. D.


Jan. 10, 1980 (Address).


WurThof Man


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


Former or Usual Residence


How long at


Place of Death ?


Days


Where was disease contracted, If not at place of death ?


Filed


190 .....


Clerk


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special information." If in a Hospital or Institution, give Its NAME Instead of street and number. t In case of married or divorced woman, or widow. # State or country ; also city, town or county, if known.


§ Name and address of person giving statistical detalls. Il Name of cemetery.


FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL


PŁACE OF BURIAL OR REMOVAL !!


DATE OF BURIAL


1- 2


....... 190.0


UNDERTAKER H. B. S.249 14


ADDRESS


LHtem nosti


2 Lydia 4- b umamigo Jan 9 - 1910


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH Lavinia am Bernstein


Wimhof


(CITY OR TOWN.)


FULL NAME


Place of l


Death * S


17 cliff ave


Residence


Age


550


. years.


4


.. months.


22


.days


STATISTICAL DETAILS


SEX


Ferner


COLOR


white


SINGLE, MARRIED, WIDOWED, OR DIVORCED


manuel


MAIDEN NAME t


Hawes


HUSBAND'S NAME +


Geo. S. Bernstein


BIRTHPLACE #


NAME OF


FATHER


Soloman Hames


BIRTHPLACE


OF FATHER$


new york Cay


MAIDEN NAME


OF MOTHER


Elizabete Pariser


BIRTHPLACE


OF MOTHER #


new Yorkaya


OCCUPATION


INFORMANT § Sw. S. Bernstein


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from Due,28 1909 to Many 14.1960 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Berchal Hemorrhage


Contributory :


General tratty Dequeation


(Signed)


Thousandthegott


(DURATION) DAYS


M.D.


Lang, 151980 (Address)


.........


witteof has,


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents. How long at Place of Death ? . years.


months.


.. days


Where was disease contracted, If not at place of death ?


Filed


190


Clerk


PLACE OF BURIAL OR REMOVAL II


DATE OF BURIAL


1/16


196.0


UNDERTAKER


ADDRESS


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.


t In case of married or divorced woman, or widow. # State or country ) also city, town or county, If known.


§ Name and address of person giving statistical details. If Name of cemetery.


ALL NAMES TO BE IN FULL


Registered No.


Date of l


Death 1


196 0


...... (DURATION). .... .DAYS


3


Lamina Que Becustein Jan. 14 - 1910


ALL NAMES TO BE IN FULL


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


Marita. E. Roach Rochel


FULL NAME


Death * S


Residence


Age


76


.years


.months.


2. 2


.days


STATISTICAL DETAILS


SEX


COLOR


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME + anderson


HUSBAND'S NAME


John andrew Jackson Rouch


BIRTHPLACE#


NAME OF FATHER


BIRTHPLACE


OF FATHER#


Denmark


MAIDEN NAME


OF MOTHER


abagiel. Pinkham


BIRTHPLACE


OF MOTHER#


OCCUPATION


INFORMANT §


Cha.S. Roach


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from tony 11 1960 to Jony 14 1960, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : addisona Disease


7


GERATIONS.


DAYS


Contributory :


. (DURATION) -DAYO


(Signed).


M.D.


Jany 15 1960


.. (Address).


Muchos more


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents. How long at .months. ..................... .days Place of Death ? years. ....... .......


Where was disease contracted,


If not at place of death ?.


.....


Filed


.190


Clerk


PLACE OF BURIAL OR REMOVAL II


DATE OF BURIAL


1/16


1960


UNDERTAKER


ADDRESS


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under " Special Information." If In a Hospital or Institution, give its NAME Instead of street and number.


t In case of married or divorced woman, or widow. # Stato or country] also city, town or county, If known.


§ Name and address of person giving statistical detalls. Il Name of cemetery.


Registered No .. arad,


Place of 1


30 Fiam New Street


Date of ¿


Death


Tau


1490


1900


6


Charles a. Rideaux Jan 18, 1910


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


Winthro Mass (CITY OR TOWN.)


FULL NAME


Wilfred


Partite Pestell


:. Registered No.


Place of


. Death *


$72 Crystal Cove are Writtena day Death'S


Date of : Jan 18


1900


Residence


72 Crystal Cove Ive Winthrop Mas Age


63


.. years.


10


.months. - .days


STATISTICAL DETAILS


SEX


COLOR


an


SINGLE, MARRIED, WIDOWED, OR DIVORCED


Marrue


MAIDEN NAME Ť


HUSBAND'S NAME +


BIRTHPLACE#


England


NAME OF


FATHER


Destill


BIRTHPLACE


OF FATHER#


England


MAIDEN NAME


OF MOTHER


-


Scolner ac. 18 1900 (Address) Minetrafo


BIRTHPLACE


OF MOTHER#


OCCUPATION England


none


INFORMANT §


H a. Pertill Somerville Mass


PLACE OF BURIAL OR REMOVAL II


7 Woodlawn


futuro Mass


DATE OF BURIAL


Jau' 21


1990


UNDERTAKER Francism Wilson


ADDRESS Somerville Mass


H


PHYSICIAN'S CERTIFICATE


' I HEREBY CERTIFY that I attended deceased during last illness, from Jaw. 15 1900 to Pau 18 1980; that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Barebone Hemorrhage Kage.


(DURATION).


DAY8


Contributor:Metroe Regurg


(DURATION) DAY8


(Signed)


Brf Porte


M.D.


SPECIAL INFORMATION only for Hospitals, Institutions, Transients,


or Recent Residents.


How long at


Place of Death ?


months.


days


years


Where was disease contracted,


If not at place of death ?


Filed


190 .....


Clerk


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If In a Hospital or Institution, give Its NAME Instead of street and number.


t In case of married or divorced woman, or widow.


* State or country; also city, town or county, If known.


§ Name and address of person giving statistical details. Il Name of cemetery.


ALL NAMES TO BE IN FULL


6 alfred Pertell Jan 1 8, 1910.


T


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


FULL NAME


Registered No.


Place of Death *


Cor. atlantic av and finition St


Date of Death


Jan. 27. 1910


Age


86


.. years


.. months


.days


STATISTICAL DETAILS


SEX


COLOR


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME Ť


HUSBAND'S NAME +


BIRTHPLACE #


Winthrop Mass.


NAME OF FATHER Washington Tewksbury


BIRTHPLACE


OF FATHER #


Funchal maso


MAIDEN NAME


OF MOTHER


faunak Floyd.


BIRTHPLACE OF MOTHER # Winthrop Maso.


OCCUPATION Retired


INFORMANT §


PLACE OF BURIAL OR REMOVAL II


DATE/ÓF BURIAL


ADDRESS


UNDERTAKER H.C. Skaggs


2 Human Sf


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from Sipt


1902 ... to pam 27 that to the best of my knowledge and beMef death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Cancer 1 Imach


1


(DURATION)


1 years


Contributory :


(DURATION) ... DAYS


(Signed)


M.D.


Am 25 196 (Address).


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


Former or Usual Residence


How long at Place of Death ? Days


Where was disease contracted, if not at place of death ?


Filed


190


Clerk


* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give Its NAME Instead of street and number.


t In case of married or divorced woman, or widow.


# State or country ; also city, town or county, If known.


§ Name and address of person giving statistical details. il Name of cemetery.


ALL NAMES TO BE IN FULL


7 Lorenzo 6 . Tewksbury Jan. 27, 1910


COMMONWEALTH OF MASSACHUSETTS.


RETURN OF A DEATH-1910.


CITY OF BOSTON.


FULL NAME


Louisa M P Gay


Registered No.


974


Place of Death }


Boston


Now Eng. Baptist Hospt.


and Residence S


Date of Death


Jan. 29


1910.


Age


69


. years


.......


.. months.


2


days.


STATISTICAL DETAILS.


SEX


COLOR


F


SINGLE, MARRIED, WID., DIV. W


Maiden Name


Parker


George F Gay


R


-....


: Primary (Duration)


OFICE


BOSTONIA CONDITA AD.


Name of


Nathaniel Parkers


1830.


Father ..


Birthplace


Groton Mass,


of Father


Maiden Name


of Mother


Mary B Parker


Birthplace


Hollis, Mass.


of Mother


Occupation


NTone


Informant


Place of Burial


Cambridge "Mt Auburnit


or removal.


Undertaker A L Eastman Co.


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


.1910,


from 1910, to that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows:


ST


RAR'S


PATRIBUS SITO


Angina Pectoris - 10 min


Husband's Name


CITY:


Birthplace


Boston


STVTTATISR


ISREGIMEIN


ON


MA S.S.


Contributory : 2


Sclerosis of coronary artery


(Duration)


2 yrs


(Signed)


J H Pratt


M.D.


Jan.31


1910.


SPECIAL INFORMATION from Hospitals, Institutions, Transier.ts, or Recent Residents.


Usual Residence


Winthrop


Filed


....


Feb. 2


1910.


A true copy.


Attest :


Ermelene


Registrar.


TH


NATA A.1822


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWNY


FULL NAME


Balu Stravan


Place of l


melial Hospital


Death *


S


Residence 425- Strithrop St.


Age


.years.


Z .... months.


days


STATISTICAL DETAILS


SE male


COLOR white


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME +


HUSBAND'S NAME +


BIRTHPLACE #


NAME OF FATHER Herbert Moltion Shorey


BIRTHPLACE OF FATHER$ allstore Mass.


MAIDEN NAME OF MOTHER


marion alice Bom


BIRTHPLACE OF MOTHER $ Somerville. Mass.


OCCUPATION


INFORMANT §


Herbert hollow Shorey


PLACE OF BURIAL OR REMOVAL II Winthrop Cemetery.


DATE OFNURIAL teb 3 198Cl.


UNDERTAKER


ADDRESS


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attendedh deceased during last illness, from .. tpm 31 196 ...... to .. pm 31 196 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Induced labor


Primary : Sull hom


DAYS


Contributory :


(DURATION) ... DAY8


(Signed)


M.D.


feb-2- 190.


.. 190 ..


.(Address)


Lush mars


SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.


How long at Place of Death ? .. years. ..........


. months. .. day


Where was disease contracted, if not at place of death ?.


Filed


.190


Clerk


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or institution, give its NAME instead of street and number.


t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.


§ Name and address of person giving statistical details. Il Name of cemetery.


ALL NAMES TO BE IN FULL


Registered No.


Date of law 31


1995


Death


Premative


8 Baby Sharey Jan 21 - 19/10 1


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


Mary Elizabeth Bucket


Registered No ..


Date of l


Death S


1990


Death * S


Residence


Age


41


......


.. years.


X


.. months. ١٠ .days


STATISTICAL DETAILS


SEX


COLOR


SINGLE, MARRIED, WIDOWED, OR DIVORCED


-


MAIDEN NAME + Guddes


HUSBAND'S NAME +


John. Buchet


BIRTHPLACE Melanie


NAME OF


FATHER


BIRTHPLACE


OF FATHER+


MAIDEN NAME


OF MOTHER


Marcha. MIC Combs


BIRTHPLACE


OF MOTHER ៛


theland


OCCUPATION


1.


INFORMANT § John. Bethel


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from m 29 196 ...... to 76-24 190 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Pneuming.


. (DURATION)


5


DAY3


Contributory :


(DURATION). -DAY8


(Signed)


M.D.


2.130


.190 ..


.. (Address)


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


How long at


Place of Death ?


years


months ........................ days


Where was disease contracted, If not at place of death ?


Filed


.190


Clerk


PLACE OF BURIAL OR REMOVAL II


DATE OF BURIAL


tub 6


19d.J.


UNDERTAKER CR Jumuson


ADDRESS


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give its NAME Instead of street and number.


t In case of married or divorced woman, or widow. # State or country; also city, town or county, if known.


§ Name and address of person giving statistical detalls. II Name of cemetery.


ALL NAMES TO BE IN FULL


Place of l


101 Valmont LL


....


9 mary Elizabeth Bechal.



COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


Baby"


Freeman


Registered No.


Date of ¿


Death 1


1960


Death *


Residence


Age


.days


STATISTICAL DETAILS


SEX


COLOR


10


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME +


HUSBAND'S NAME t


BIRTHPLACE #


NAME OF FATHER frederick. ... freeman


BIRTHPLACE


OF FATHER$


Sherlow ?? Y.


MAIDEN NAME


OF MOTHER


Clara. Snikerder


BIRTHPLACE


OF MOTHER $


Holoyoke Mars


OCCUPATION


INFORMANT § Frederick. H. Fellman


PHYSICIAN'S CERTIFICATE


[ HEREBY CERTIFY that I attended deceased during last illness, from. 190


.... to. 1900 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :


Primary : Still borg Infant


(DURATION) .. DAYS


Contributory :


(DURATION). DAYS


(Signed)


M.D.


This .


5 1900 (Address)


petrol, mans.


SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.


How long at Place of Death ? . years.


.. months. days


Where was disease contracted, If not at place of death ?


Filed


190


Clerk


PLACE OF BURIAL OR REMOVAL II


DATE OF BURIAL


2/4


1900


UNDERTAKER


ADDRESS


* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.


t In case of married or divorced woman, or widow.


# State or country; also city, town or county, If known.


§ Name and address of person giving statistical detalls.


|[ Name of cemetery.


ALL NAMES TO BE IN FULL


Place of l


36 nevada IL


10 Baby Freeman Fab- 3-1910


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


FULL NAME


David a. floyd.


Registered No.


Place of Death *


230 Lincoln St. Haithink Tank.


Date of Death


Ful. 5-1910.


Age.


71 years


7 months.


20 days


STATISTICAL DETAILS


SEX


COLOR


10


SINGLE, MARRIED,


WIDOWED, OR


DIVORCED


MAIDEN NAME Ť


HUSBAND'S NAME +


BIRTHPLACE# Winthrop.


NAME OF


FATHER


David Floyd.


BIRTHPLACE


OF FATHER


MAIDEN NAME


OF MOTHER


BIRTHPLACE


OF MOTHER #


Winthrop


OCCUPATION Retired


INFORMANT § I Aloud.


PLACE OF BURIAL OR REMOVAL !!


DATE OF BURIAL Freb. 8 19/0.


UNDERTAKER HC. skaggs.


ADDRESS It umcon sit


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from Jan 190 G.to Feb 5 1900 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Brights disease


(DURATION).


.....


. DAY8


Contributory :


Complication of disease


(enlarged prostate etc)


0


(DURATION).


........... DAYS


(Signed)


Horace


Soule


.M.D.


Fuel 5


19Q.Q. (Address)


Winthrop Mass


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


Former or Usual Residence


How long at


Place of Death ?


Days


Where was disease contracted, If not at place of death ?


Filed


190


Clerk


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, glvo Its NAME Instead of street and number.


t In caso of married or divorced woman, or widow. # State or country ; also city, town or county, If known.


§ Name and address of person giving statistical detalis. 1/ Name of cemetery.


ALL NAMES TO BE IN FULL


11 Here's a Floyd. feb-5-1910


[1.'09-37-XXXM.]


Permit No. .......


RETURN OF DEATH. BOSTON, MASS.


Date of Death, Elle 8th


19/0.


Name in full, ..


William J. Lunch


(If married or divorced woman give maiden name, also name of husband.)


Sex,


male


Color


White


Condition,


Married


(White, Black, Mixed, Chinese,


Indian, etc.)


Retired


(Single, Married, Widowed or Divorced.)


Age,


5) Years, -


Years, - Months, Days. Occupation,


Residence,* 54 Lingoln


Ward,


Place of Death, 54 Lincoln


Place of Birth,


New york NY. Date of Birth,


(State year, month and day -


Name and Birthplace )


John Lynch-


Ireland


of Father, Maiden Name and Birthplace of Mother, Mary Taggart- Ireland


Place of Interment,


Holy Broad Walden


* If an institution, state how long an inmate and previous residence.


M. J. Kelly


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Boston,


Fab. 9


19.10.


Name and Age !


Age, 57 years.


I hereby certify that I attended deceased from.


19v4,to


19\\, that I last saw


alive on the.


that died on the


day of


19 10 , about.


11


o'clock


A.M., or P.M., and that, to the best of my knowledge and belief, the cause of


death


was as follows:


Exhaustion


Disease S chief cause,


Contributing cause,


Chief Cause,. مسا سينا


Duration


Contributing cause,. 1


M. D.


DET PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.


.01


of Deceased,


IVille


Ju day of. 19 40,


s


LIST OF INDEFINITE TERMS WHICH SHOULD BE AVOIDED IN GIVING CAUSES OF DEATH.


Acute gastritis. State cause. Was it due to some irritant poison ?


Ascites. Name disease causing ascites. See "Dropsy."


Asphyxia.


How? Was it accidental? If so, state fully the nature of the accident. If by gases or poisonous vapors, give particulars. Was it a case of "overlying" (child) ? What disease caused this condition ?


Asthenia. A practically worthless statement. See "Debility." What was the cause?


Atrophy. What caused the atrophy? Was it tuberculous wasting (phthisis) ? Was it syphilis? What organ or part atrophied ?


Blood poisoning.


Do you mean septicemia, syphilis, or any other definite disease? If septicemia, what was the cause? Was it puerperal?


Chronic


pneumonia.


Con


.. on of


Convulsions.


Was this not pulmonary tuberculosis?


Was it acute bronchitis, broncho-pneumonia, or lobar- pneumonia? If so, state definitely. Was it passive or hypostatic congestion ? If so, name disease causing the condition.


Debility.


What caused the debility? Name the acute or chronic disease. Debility might follow typhoid fever, diph- theria, tuberculosis, Bright's disease, and a host of other causes. The return is worthless and should never be made.


-1


Pyemia. What caused the pyemia? Was it puerperal or trau-, matic? If traumatic, state nature of accident causing injury.


Senile asthenia. See "Old age" and "Asthenia." death.


Give disease causing


Senile atrophy. See "Old age" and "Atrophy." death.


State disease causing


Senile decay. See "Old age." State disease causing death.


Senile decline. See "Old age." Name the disease, if any, that caused the decline.


Senile marasmus. See "Old age" and "Marasmus." Name disease causing death.


Shock. What caused the shock? If from injury, state nature of accident. If from surgical operation, state disease or injury requiring the operation.


Surgical operation. Surgical shock.


Always state the disease or injury requiring operasiun. Unless the operation was improper or unskilfully per- formed, it should not be given as the primary cause o death.


Tcething. Name the disease affecting the teething child. See "Den tition."


Toxemia.


Was this acute or chronic poisoning due to some externa agent? Was it auto-intoxication, due to poisons gen erated in the body by disease? If so, state the nam of the disease.


Tuberculosis. State organ affected. Do not fail to state as pulmonar tuberculosis if lungs were affected.


'Tumor. Was it a cancer? Whether a cancer or tumor, do not fa to specify organ or part of body affected.


Typhoid condition. Avoid this term as it is likely to be mistaken for typho fever.


Typhoid pneumonia.


Was the primary disease typhoid fever or pneumonia ?


Inanition.


This is a particularly pernicious term and is responsible for a multitude of worthless certificates. It sounds as if it meant something definite, but, in the majority of cases, it does not. What disease caused the inanition ? Was it syphilis, tuberculosis, cholera infantum? If inability to take food, state cause.


Infantile asthenia. See "Asthenia." The term "infantile" adds no precision to an indefinite statement.


Infantile atrophy. See "Atrophy."


Malassimilation. What disease caused the malassimilation ?


Malnutrition. What disease caused the malnutrition ?


Marasmus. What disease caused the "marasmus" ? Was it due to tuberculosis, syphilis, or cholera infantum? State fully, as this return in itself is practically worthless for compilation.


Meningitis. Was it'epidemic cerebro-spinal meningitis? If so, write exactly in this form Did it follow scarlet fever, pneu- monia, or some acute infection? If so, name the pri- mary disease. Was it traumatic? If so, state the nature of the violence which caused the meningitis. Was it tuberculous meningitis?


Nephritis. Was it acute or chronic? · If acute, occurring in the course of some disease, name the disease causing death.


Old age. This is not a satisfactory return. The influence of age is shown by the statement of age in years, months, and days. To this the statement of "old age" as a cause of death adds nothing of value. Name the disease to which the old person succumbed.


Peritonitis. What was the cause of the peritonitis? "Idiopathic peri- tonitis" should be rarely returned. Was it puerperal or traumatic? In the latter case, state mode of injury.


Pernicious anemia. If any definite cause can be assigned for the anemia, it should be reported. Anemia due to tuberculosis, syph- ilis, etc., should be returned under the primary disease.


Dentition.


What was the disease causing death of the teething child? "Dentition" is not a proper cause of death, and, like "infantile" and "old age," does little except to mark the approximate age of decedents.


Dropsy.


Name the disease in which the "dropsy" occurred.


Dyspepsia.


Was there organic disease of the stomach or other organs ? If so, name the disease causing death.


Eclampsia.


Give cause of convulsions. Were they puerperal?


Edema of lungs.


Give cause. See "Congestion of lungs."


Gastric fever.


A worthless return. Was it acute gastritis (q. v.) or some definite form of fever, as typhoid, malarial, etc. ?


General paralysis.


If extended paralysis resulted from cerebral hemorrhage, the cause should be given and the expression "general paralysis" should be avoided. "General paralysis" should be written only for "general paralysis of the insane," or paretic dementia, and the statement of the fact of insanity should always be included.




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.