USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 19
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Date of ¿
March 25
Death
1
190 g
36 Hattie Douglas. 1 march 205-09
COMMONWEALTH OF MASSACHUSETTS
Dculturale
(CITY OR TOWN)
FULL NAME
Edward francis Cukety
Place of
Death *
Minthafe Mace
Residence
59 Real Steel
Age.
.. years.
1
months days
STATISTICAL DETAILS
SEX
male
COLOR
Write
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE#
Hinttirage mars
NAME OF
FATHER
Melbourne B, Tewksbury
BIRTHPLACE OF FATHER# Northrope Mars
MAIDEN NAME OF MOTHER Helen F, Fairchild
BIRTHPLACE OF MOTHER + Lyme @low Hampshire
OCCUPATION
INFORMANT §
Father
Tellaune B. Jenkshuy
Filed
190
Clerk.
PLACE OF BURIAL OR REMOVAL II Vaistrop. Cemetery
DATE OF BURIAL
190
UNDERTAKER
Summer Floyd
ADDRESS Wirthnin
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190. .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 :
(DURATION).
... DAYS
Contributory :
(DURATION) .. DAYS »
(Signed)
M.D.
Mch 26 1909 (Address)
worth moss
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 ?
.....
* 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. f 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. || Name of cemetery.
ALL NAMES TO BE IN FULL
RETURN OF A DEATH
.Registered No.
Date of Į
Death
Man. 15th
1909
one must
37
6 award Francis Decokatury March 25, 19 09.
COMMONWEALTH OF MASSACHUSETTS.
Vintluogo
(CITY OR TOWN.)
FULL NAME
Pourcy & Davison
.Registered No.
Place of
Death *
Diantenales mars
Date of March 26" 1909
Death
Residence
26 Ingleside Que
Age
72
.years.
months.
... days
STATISTICAL DETAILS
SEX Shemale While
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Lovicys, White
HUSBAND'S NAME +
John H. Daviem
BIRTHPLACE #
Plymouth UP
NAME OF
FATHER
George H. While
BIRTHPLACE OF FATHER# Plymouth
MAIDEN NAME
OF MOTHER
Emma Paddock
BIRTHPLACE
OF MOTHER $
Bomper VR
OCCUPATION Honsempe
INFORMANT §
Daughter
PLACE OF BURIAL OR REMOVAL !!
Vermont
UNDERTAKER
ADDRESS
Junier Floyd Menthol
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, fro march 3, 1909 to march 26, 1909 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: Ciente Santarita,
(DURATION). 23 .DAYS
Contributory :
Chronic Bronchitis.
(DURATION) 10 000 suva
(Signed)
.M.D.
Jean. 26, 1909 (Address)
Ent Ret, ma
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at . months: Place of Death ? . years. ...... ....... 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
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
DATE OF BURIAL
190.
5
RETURN OF A DEATH
COLOR
38
Loviny P. Sanion march 26-09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of )
Death *
Anthrope Mark
Residence
30 Madison avenue
Age
74
-years.
4
months.
1.3
.days
STATISTICAL DETAILS
SEX
COLOR
Male thite-
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE#
chelsea Mars
NAME OF
FATHER
David Floyd
BIRTHPLACE
OF FATHER#
Chelsea Mark
MAIDEN NAME
OF MOTHER
Sally J. Tewksbury
BIRTHPLACE
OF MOTHER #
Chelsea Mark
OCCUPATION
Builder
INFORMANT §
Dife
PLACE OF BURIAL OR REMOVAL !! Prantropo Cemetery
UNDERTAKER
ADDRESS
Summer Floyd Dinitro 10
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from
1900 .. to met 3 / 190 1, 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 :
(DURATION
1-2%
Contributory :
Bismilculy
M.D.
april 1904 (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
* 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.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
DATE OF BURIAL
190
Cloud
Registered No.
Date of
March 31
Death
.190 9
(DURATION)
....... DAYS
(Signed)
١٠
39 Lucia Fryd . mich 31-'09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Wirthnot
(CITY OR TOWN.Y
FULL NAME
Charles
Francis turner
Registered No.
Date of
Mar 31 St
190
9
Death *
S
Residence
243 Wochenet She
Ag
32
6
.years.
.months ..
days
STATISTICAL DETAILS
SEX
COLOR
10.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
marie
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
East Surla
NAME OF FATHER thank. L. Turner
BIRTHPLACE OF FATHER+
MAIDEN NAME
OF MOTHER
Caroline Milnes
BIRTHPLACE
OF MOTHER #
Bastón
OCCUPATION
Conducto B.R.B. S.L.,PR.
INFORMANT § Stacker
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 9 ... to Nach 31 1909 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 :
landia Huvudbons.
.(DURATION)
1/24
. DAYS
Contributory :
Labor Preciosa .
-
(DURATION) ...
C. DAYS
(Signed)
M.D.
apr
3
1909
.(Address).
237 Meridian SEB
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
months.
Place of Death ?
.... years.
......
.days
Where was disease contracted,
If not at place of death ?
Filed
190
Clerk
PLACE OF BURIAL OR REMOVALI
Woodlawn Invest
maso
DATE OF BURIAL
4/4/A
190.7.
UNDERTAKER
C.R. Bennison
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 detalis. Il Name of cemetery.
ALL NAMES TO BE IN FULL
Place of l
243 WindhatIL
Death S
40 Charles Frances Turner mar 31 -- 09
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1909.
CITY OF BOSTON.
FULL NAME
Ellsworth A Glidden
Registered No .. . ..
3104
Place of Death ¿
Boston
Mass. Gen.Hospt.
and Residence S
Date of Death
Apr.3
1909.
Age
49
. years
............
months.
29
days
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
M
Maiden Name
ST ATRIBUS SIT DE T PAT
AR'S
Gen.Peritonitis, Ac.Pleuriti
Husband's Name
CIT
Primary (Duratioda JICE:
4 days
CTV BOSTONTA" CONDITAM.
Name of Father -Glidden
BOST
MA'S S.
Contributory :
Appendix abscess - 22 wks
(Duration)
(Signed)
L H Burlingham
M. D
Apr.3
1909
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recen Residents.
Admitted to hospital Mar.31,1909
Usual Residence
Winthrop(Taft Ave)
Filed
Apr.5
1909.
A true copy.
Attest :
Registrar.
.ATTATLIYOR STAY ANASTACIATAT ATTESTUTAT
Place of Burial
Belgrade, Me.
or removal
Undertaker. C Y. Shurtleff
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
1909 from 1909, 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 :
Birthplace
Belgrade, Me.
Birthplace of Father
Maiden Name of Mother
Birthplace of Mother
Occupation
Retired
Informant.
TISRI EGIMINE DONATA A
TA A. 182
Ellsworth a. Glidden арг-3-09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME A Levelles.
Registered No.
Place of
Death *
Death
190
X
.. months. / .days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER
.
BIRTHPLACE OF FATHER# Lorgan England
MAIDEN NAME . OF MOTHER Emcinco Summons
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
4/5
190. 4
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from much 26 1909 to apr 4 - 1909, 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™ mal delop ment.
(DURATION).
10
DAYS
Contributory :
(DURATION) DAYS
(Signed)
Berntralf
M.D.
190 .... (Address).
iness
SPECIAL INFORMATION only for Hospitais, 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 city, town or county, if known,
§ Name and address of person giving statistical details. Il Name of cemetery.
100 7714
ALL NAMES TO BE IN FULL CIUI _ VAII HIIM
Residence
1.
Age
....
.. years.
Date of 4/4
41
Frances Pelling apr . 4 -'09
COMMONWEALTH OF MASSACHUSETTS 01
Winthrop
(CITY OR TOWN.)
RETURN OF A DEATH Darrian Blackstone Dennett
FULL NAME
Place of l
Winthrop Wass
Death *
5
3.11 Shirley Sheet
Age
56
.. years.
months.
.days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
NAME OF
FATHER
Unknown
BIRTHPLACE
OF FATHER#
MAIDEN NAME OF MOTHER
BIRTHPLACE
OF MOTHER +
Scotland
OCCUPATION Deerales+ Painter
INFORMANT §
Trife
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from .... 190 .. ... 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 :
. (DURATION) ......... DAY8
Contributory :
(DURATION) . DAYS
(Signed)
M.D.
Clon 12. 1907 (Address). JAnitrof
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? years. .................. months. days
I
Where was disease contracted, If not at place of death ?
Filed
.190
Clerk
PLACE OF BURIAL OR REMOVAL II
Orange Mass
DATE OF BURIAL
190.
ADDRESS
UNDERTAKER Summer Floyd
* 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.
..
ALL NAMES TO BE IN FULL
.. Registered No.
Date of l
aferie 11" 190 g
Death 5
Residence
42 Hillicin Blackstone Rewelt apr 11 -1909
1
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
City nf
Cambridge Je 3
FULL NAME Julia Furgana
........
Registered No.
* Place of
18to mar avr
Cambridge
{ Date of aker 12
Dealh
1909
Place of 132 Pauline St
No.
, Street
,
Winthrop
Age 45
„Years
0
Months
0
Days
Residence
No.
Street
City or Town
STATISTICAL DETAILS
Sex
Color
Sink, Married,
Widoved or
Divorked
UMaiden Name
Ifa married or divorced woman or widow
Gillar
Husband's Full Name
Rudolfch Furgang
Birthplace
City or Town and State or Country
anbudze
1
Futt Name es Father
Emanuel Pillar
Birthplace of Falher
Untenvan-
City or Town and State or Country
Maiden Name of Molhex
Sarah
Birthplace of Molher
City or Town and State or Country Unknown
Occupation Store keeper
Informant's Name (Person giving statistical details )
Husband.
13% Pauline
No.
Street
City or Town
Place of Burial or Removal
Hand in Hand
Cemetery
Hostin
Undertaker's Name
Address
Edward
& Prach
1385 Columbus aux
12
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY lhat I altended deceased during last
illness, from. akr. 5
1909 to apr 12 190 1; that to the best of my knowledge and betief death occurred on the date slaled above, and thal the CAUSE OF DEATH was as follows : ( If a soldier or sailor who served in the war of the rebellion both the primary and contributory causes of death must be given.b
Primary :
1 Fibroid Sumer Uterus
(Duration )
Indefinite
Contributory : 1
(Duration)
(Signed)
Thury O Marcy
M. D.
(Address)
180 Simmenerdelt alar Berlin
* How long at
Place of Dealh ?
Years
Months
............... Days
Usual Residence
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Received al ochich 14 1909
Cily Clerk
Alex 'in Gear
COUNCIL
Gril City Clark
ALL NAMES TO BE IN FULL
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
Death
Name of Hospital or Institution, if any
Julia Furgang apr - 12. 04
COMMONWEALTH OF MASSACHUSETTS
Mucchio (CITY OR TOWNS
RETURN OF A DEATH
FULL NAME
Daniels
..... ..
Registered No ..
Date of ¿ Chris 1 1909
Death * S
Residence
Age
.years.
.months.
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t HUSBAND'S NAME t
BIRTHPLACE #
NAME OF
FATHER
Harry. H. Daniels
BIRTHPLACE
OF FATHER$
Chic - Pa
MAIDEN NAME
OF MOTHER
Laura . M. Rogers
BIRTHPLACE
OF MOTHER#
It Louis suo
OCCUPATION
INFORMANT § Harry. H. Daniels
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
4/16
190. 9
UNDERTAKER C. R. Benson
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from abril 14 190.9 .. to april 14 1909 Pm 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 : Premalive Infact
5 horas (DURATION). . DAYS
Contributory :
X .(DURATION) ....... DAY8
(Signed)
april 15 909
(Address).
Winthrop mars
M.D.
SPECIAL INFORMATION only for Hospitals, Institutlons, 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
* 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.
ALL NAMES TO BE IN FULL
Place of }
33 wheeler are
Death S
ADDRESS ·
4.3 Danilo ayeril 14-'09
[1-'09-37-XXXM.]
Winthrop
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
April 24Th
1909.
Name in full,. John J. Donovan'
.......
(If married or divorced woman give maiden name, also name of husband.) 1
Sex, Male Color, Whit
(White, Black, Mixed, Chinese,
Condition,
Married
Age, Years,~ .Months,
Days. Occupation,
Residence,*
45 Bral
Ward,.
Place of Death,
45 Beal Sh
(Stafe year, month and day
Place of Birth,
East Baston Maks Date of Birth,.
Name and Birthplace Timothy Donovan- Ireland of Father, Maiden Name and Birthplace of Mother, Annie M. ODonnell- Ireland
Place of Interment,
Holy Cross Malden
* If an institution, state how long an inmate and previous residence. M. A. Kelly
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
afad 24
19
afand 19 1904, to afml 2x"
Age, ...
31
years.
of Deceased,
John J. Donovan
I hereby certify that I attended deceased from.
190 }, that I last saw alive on the 24
day of
april
19 0 9
that died on the 24 day of apart
190y, about.
.o'clock
his death was as follows:
Chief cause,
Disease ‹
Contributing cause,
Chief Cause,
6 days
Duration
Contributing cause,
M. D.
- PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.
->>21
Indian, etc.)
Clark
(Single, Married, Widowed or
Divorced.)
31
Name and Age ?
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of.
Pro he numa
you zee-of
Acute gastritis. State cause. Was it due to some irritant poison ?
Ascites.
Name disease causing ascites. See "Dropsy."
Asphyxla.
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 Was it disease ? If septicemia, what was the cause? puerperal ?
Chronic pneumonia.
Congestion of lungs.
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.
Convulsions.
What caused the convulsions? Were they epileptic. puerperal, or caused by diarrhea or enteritis (infants) ? Name the disease in which the convulsions occurred. "Convulsions" are mere symptoms and should not be given as equivalent to a proper statement of cause of death.
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.
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.
Dyspepsla.
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.
Heart failure.
What disease caused the "heart failure"? The heart always "fails" before death from any cause. Be par- ticularly careful that deaths from diphtheria, tubercu- losis, etc., are not so reported. If organic heart disease is meant it should be so stated.
Hemorrhage of lungs.
Hypostatic congestion.
Imperfect nutrition.
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 asthenla. See "Asthenia." The term "infantile" adds no precisi 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 tuberculosis, syphilis, or cholera infantum? Sta fully, as this return in itself is practically worthless f compilation.
Meningitis. Was it epidemic cerebro-spinal meningitis? If so, wri exactly in this form Did it follow scarlet fever, pne monia, or some acute infection? If so, name the p mary disease. Was it traumatic? If so, state tl nature of the violence which caused the meningiti Was it tuberculous meningitis ?
Nephritis. Was it acute or chronic? If acute, occurring in the cour of some disease, name the disease causing death.
Old agc.
This is not a satisfactory return.
The influence of age
shown by the statement of age in years, months, ar
days. To this the statement of "old age" as a cause
death adds nothing of value. Name the disease
which the old person succumbed.
Peritonitis. What was the cause of the peritonitis? "Idiopathic pe tonitis" should be rarely returned. Was it puerper or traumatic? In the latter case, state mode of injur
Pernicious anemia. If any definite cause can be assigned for the anemia, should be reported. Ancmia due to tuberculosis, syp ilis, etc., should be returned under the primary diseas
Pneumonia. Specify definitely whether broncho-pneumonia or loba pneumonia. If sequel to influenza, state that fact.
Pyemia. What caused the pyemia? Was it puerperal or tra matic? If traumatic, state nature of accident causi injury.
Senile asthenia. See "Old age" and "Asthenia." death.
Give disease causi
Senile atrophy. See "Old age" and "Atrophy." death.
State disease causi
Senile decay.
See "Old age." State disease causing death.
Senile decline.
See " Old age." Name the disease, if any, that caused t.
decline.
Senile marasmus.
See "Old age" and "Marasmus." Name disease causi
death.
Shock. What caused the shock? If from injury, state nature accident. If from surgical operation, state disease injury requiring the operation.
Surgical
operation.
Surgical shock.
Always state the disease or injury requiring operatio Unless the operation was improper or unskilfully pe formed, it should not be given as the primary cause death.
Teething.
Name the disease affecting the teething child. See "De tition."
Toxemia.
Was this acute or chronic poisoning due to some extern agent ? Was it auto-intoxication, due to poisons ge erated in the body by disease? If so, state the nar of the disease.
Tuberculosis. State organ affected. Do not fail to state as pulmona tuberculosis if lungs were affected.
Tumor. Was it a cancer? Whether a cancer or tumor, do not f: to specify organ or part of body affected.
Typhoid condition.
Avoid this term as it is likely to be mistaken for typho fever.
Was the primary disease typhoid fever or pneumonia ?
Typhoid pneumonia.
Typho-malarial fever.
Was it typhoid fever? Was it malarial fever? A mi ture of these diseases rarely occurs, the great majori of cases of so-called "typho-malarial fever "[being not ing more nor less than typhoid fever.
State name of disease causing imperfect nutrition. Did it
follow some disease? If so, give name of disease.
Was this not due to pulmonary tuberculosis? If so, the primary cause should be reported without fail.
Name the disease causing the passive or hypostatic con- gestion.
LIST OF INDEFINITE TERMS WHICH SHOULD BE AVOIDED IN GIVING CAUSES OF DEATH.
Was this not pulmonary tuberculosis?
STRY
DEPT.
RE
MAY 4 1909
Permit No. 172
RETURN OF A DEATH. N. Br
BOSTON, MASS.
Name in full, andrew
Date of Death, Kelly
april 26 909
mamed.
(If married or divorced woman give maiden name, also name of husband.)
Sex, Color, .. Muito
Condition, married
(White, Bình, wired, Chiese;
(Single) Married, Widowed or Diremed.) Age, 47 Years, ~ Months, - Days. Occupation,
Irsherman
72 Bolton Street SoBoston Residence, . Place of Death, Boston Harbor as Hinthrop
Ward 13.
(State year, month and day.)
Date of Birth, Place of Birth, Leland A Keland. mare Donalive - Deland
Calsang
che vr Taury Don Undertaker.
Certificate of the Medical Examiner.
I hereby certify that andrew Kille
age. 6.0 gms, residence, 124 SB. Dor am., So Balin
- who died on the 26 th? day of
came to death from
Cause :
Manner :
Unknown- probably accidental
M. D., Medical Examiner for Suffolk County.
...
1
er's No. 1346
[12.'08-VC.] Medical Examin THE THE
COUNTERS:AMEO BOARD OF HEAT MAY 4 1909
-
Name and Birthplace of Father, Maiden Name and Birthplace of Mother, S Place of Interment,
Andrew Jelly April 26-1909
COMMONWEALTH OF MASSACHUSETTS
Scritture
(CITY OR TOWA.)
FULL NAME
Mary Jane Della
Registered No.
Place of )
Startujemais
Death *
Residence
54 Shirley Street
Age
23
years ..
.months.
10
.. days
STATISTICAL DETAILS
SEX Female!
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
Mary Jane morgan Salu Di Hellman
BIRTHPLACE # Pim mars
NAME OF FATHER Themas Morgan
BIRTHPLACE
OF FATHERT
Milfordeline England
MAIDEN NAME
OF MOTHER
Mary Jane Hughes
BIRTHPLACE OF MOTHER+ New Brighton England
OCCUPATION Phone
INFORMANT §
mother
many ), morgan
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 ..
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