USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 20
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.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 : Tuberculosis Stheargy
(DURATION) DAY8
Contributory :
(DURATION) . DAYS
(Signed) ..
A. B Sorman
M.D.
las/4909 (Address)
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 !!
DATE OF BURIAL
190
UNDERTAKER
ADDRESS
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, glve facts called for under "Spoclal Information." If In a Hospital or Institution, givo Its NAME Instead of street and numbor.
t In case of marrled or divorced woman, or widow. # Stato or country ; also city, town or county, If known,
§ Name and address of person giving statistical detalls. Name of cemotery.
ALL NAMES TO BE IN FULL
RETURN OF A DEATH
Date of l
may 6'
.190
Death
46 mary Jane Hollwaw may 6-1909
Still Born
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Sheehan
Registered No ...
Date of ¿
Death 1
190 9
Residence
19 50 Lurcolon IL
Age
.months. .days
STATISTICAL DETAILS
SEX Ternace
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE+
NAME OF FATHER
1
BIRTHPLACE OF FATHER+
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER $ Cheleen
OCCUPATION
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from 1904 .. to muy 8 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 : Prematin both
.(DURATION).
-DAYS
Contributory :
(DURATION) . DAY8
(Signed)
M. D.
Marco. 1909 (Address) 174 Auchwest
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
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
190.
UNDERTAKER
ADDRESS
* City or town, street and numbor, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." if In a Hospital or Institutlon, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
1 State or country; also city, town or county, if known.
§ Name and address of person giving statistical detalis. Il Namo of cemotery.
L
Place of ¿
Death *
S
metrael Hospital
ALL NAMES TO BE IN FULL
6 hours
1
47 She how May 8, 1909
1
[1-'09-37-XXXM.]
Permit No. .....
RETURN OF DEATH. BOSTON, MASS.
Date of Death, May 9, 19.09 ....
Name in full, Earle Park Batstone.
(If married or divorced woman give maiden name, also name of husband.)
Sex, Male, Color, White Condition, ..... .Single
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 2 Years, 11 Months, .. 3 Days. Occupation,. .None
Residence,* 72 Herman St. Winthrop, .... Mass .. Ward,
Place of Death, 72 Herman St. Winthrop, Mass. May 9, 1909.
(State year, month and day.)
Place of Birth, .. Newton, Mass.
Date of Birth, June 6, 1908.
Name and Birthplace 1 Frank Batstore ........ Fast.Boston .... L'ass. ...... of Father,
Maiden Name and Theodosia Park. Newton, Mass.
Birthplace of Mother, S
Place of Interment, Newton Cemetery, .. Newton, ... Mass ..
* If an institution, state how long an inmate and previous residence. George thengt Ion Undertaker S newtonville
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, May 9. 19.09.
Name and Age !
of Deceased, Carl Batitone
Age,. 13 years.
I hereby certify that I attended deceased from. May 4 1909, to. May 9.
1909, that I last saw
.... alive on the. .. day of. may 1909. that .. Le died on the.
day of may
1909, about 1000 o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. Les death was as follows:
Disease Chief cause, Urammig Commelecore
Contributing cause,
Chief Cause, 1 day
Duration
Contributing cause, 2 fears
M. D.
PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.
21
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.
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 disease? If septicemia, what was the cause? Was it puerperal ?
Chronic pneumonia.
Congestion of lungs.
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.
Was there organic disease of the stomach or other organs? If so, name the disease causing death.
Eclampsia.
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 asthenia. See " Asthenia." The term "infantile" adds no precisio to an indefinite statement.
Infantile 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 compilation.
Meningitis.
Was it epidemic cerebro-spinal meningitis? If so, wr exactly in this form Did it follow scarlet fever, pn monia, or some acute infection? If so, name the y mary disease. Was it traumatic? If so, state nature of the violence which caused the meningi Was it tuberculous meningitis?
Nephritis. Was it'acute or chronic? If acute, occurring in the cou of some disease, name the disease causing death.
Old age.
This is not a satisfactory return. The influence of ag shown by the statement of age in years, months, days. To this the statement of "old age " as a caus death adds nothing of value. Name the disease which the old person succumbed.
Peritonitis. What was the cause of the peritonitis ? "Idiopathic p tonitis" should be rarely returned. Was it puerp or traumatic? In the latter case, state mode of inj
Pernicious anemia.
If any definite cause can be assigned for the anemia
should be reported. Anemia due to tuberculosis, sy
ilis, etc., should be returned under the primary dise
Pneumonia.
Specify definitely whether broncho-pneumonia or lo
pneumonia. If sequel to influenza, state that fact
Pyemia.
What caused the pyemia? Was it puerperal or t matic? If traumatic, state nature of accident cau injury.
Senile asthenia.
See "Old age" and "Asthenia." death.
State disease cat See "Old age" and "Atrophy." death.
Senile atrophy.
See "Old age." State disease causing death.
Senile decay.
Senile decline.
See "Old age." Name the disease, if any, that cause decline. See "Old age" and "Marasmus." Name disease ca death.
Shock.
What caused the shock? If from injury, state natu accident. If from surgical operation, state disea injury requiring the operation.
Surgical operation. Surgical shock.
Always state the disease or injury requiring opera Unless the operation was improper or unskilfully formed, it should not be given as the primary cat death.
Teething.
Name the disease affecting the teething child. See' tition."
Toxemia.
Was this acute or chronic poisoning due to some ext agent? Was it auto-intoxication, due to poisons erated in the body by disease? If so, state the of the disease.
Tuberculosis.
State organ affected. Do not fail to state as pulm tuberculosis if lungs were affected.
'Tumor. Was it a cancer? Whether a cancer or tumor, do n to specify organ or part of body affected.
Typhoid condition.
Avoid this term as it is likely to be mistaken for ty fever.
Was the primary disease typhoid fever or pneumoni
Typhoid pneumonia.
Typho-malarial fever.
Was it typhoid fever? Was it malarial fever? ture of these diseases rarely occurs, the great ma of cases of so-called "typho-malarial fever " being ing more nor less than typhoid fever.
Give disease cau
Name the disease in which the "dropsy" occurred.
Dyspepsia.
Give cause of convulsions. Were they puerperal?
Edema of lungs.
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.
State name of disease causing imperfect nutrition. Did it follow some disease? If so, give name of disease.
See "Atrophy."
Name disease causing ascites. See "Dropsy."
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.
Senile marasmus.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Margaret M. Patchet
Registered No ...
Place of l
Pinchitos, Mais
Death * S
Residence
1a, Charles Street
Age
24
.. years
.months ....
... days
STATISTICAL DETAILS
SEX Female
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
margaret In Buce
HUSBAND'S NAME +
James Hd, Patchett
BIRTHPLACE #
Scotland
NAME OF
FATHER
Robert Bruce
BIRTHPLACE
OF FATHER#
Scotland
MAIDEN NAME
OF MOTHER
Unknown
BIRTHPLACE
OF MOTHER #
Scattain
OCCUPATION none
INFORMANT § Justund James Jd, Patchett
PLACE OF BURIAL OR REMOVAL II
Minitrop Perneley
UNDERTAKER Dummer Floyd
DATE OF BURIAL
190
ADDRESS
Wirtrop
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from aquil 24 190 ...... to May 10 1909 t 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 : Ruftund Ectopre Testafin
(DURATION). . DAYS 1
Contributory :
General Pendenitis
(DURATION). 8 DAYS -
(Signed) Braun Hillings .M.D. May 10 1900 (Address) 267 Mastungtin avc. .
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.
A
Date of l
May 10
Death
S
.1909:
49 margaret m. Patchet May 10 - 1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Winchuk (CITY OR TOWN.)
FULL NAME
alles J. Sawyer
Place of
5 Paulini dt 0
Death *
S
Death
Residence
Age
43
.. years
months. .days
STATISTICAL DETAILS
SEX m.
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE# Authorof Mass
NAME OF FATHER i John D. Danger
BIRTHPLACE OF FATHER#
MAIDEN NAME
OF MOTHER
Sarah. E. Tillett
BIRTHPLACE OF MOTHER # no Wakefield me
OCCUPATION
INFORMANT § machen.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. may 10 1909 to Imay 13 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 : acute articles Rheumats
(OURATION)
8
.DAYS
Contributory :
Hent Pauline
.
(DURATION).
2
R .. DAY8
(Signed).
M.D.
my15 1909 (Address).
174 hulp of
SPECIAL INFORMATION only for Hospitais, 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
* 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.
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
9
190.
UNDERTAKER
ADDRESS
Registered No. .
Date of ¿ may13
9 1909
8
50 albert J. Sawyer May 1 3, 1909
COMMONWEALTH OF MASSACHUSETTS"
Naturo
(CITY OR TOWN.)
Rosette Covenant Schryver
.Registered No ..
Place of l
Warthogs
mass
Date of
may 13'
190
Residence
Lolist avenue
Age
.. years .. months .days
STATISTICAL DETAILS
SEX teruale
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Roxette lo verant
HUSBAND'S NAME +
Boloman Schipper
BIRTHPLACE #
ameterdam Holland
NAME OF
FATHER
Marcus boerand
BIRTHPLACE
OF FATHER+
Amsterdam Holland
MAIDEN NAME
OF MOTHER
Sarah Jacobs
BIRTHPLACE
OF MOTHER #
amsterdam Holland
OCCUPATION
INFORMANT § Husband
Dreamon Schryver
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jetti5, 1906 to May 13th 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 : Diabetes Mellitus
(DURATION) .. DAY8
Contributory :
(Signed)
Thomas & Pigott
DURATION) .. DAY8
.M.D.
may 13
Winthrop, Maso.
SPECIAL INFORMATION only for Hospitals, Institutlons, 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 "Speclal Information," If In a Hospital or Institution, glve 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.
PLACE OF BURIAL OR REMOVAL II Knollwood Cemely
UNDERTAKER Summer Floyd
DATE OF BURIAL
May 16. 1909
ADDRESS
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
RETURN OF A DEATH
FULL NAME
Death * S
Death
S
.. .
.. 190.4 ... (Address)
51 Rosette loveraut Schyrer May 1 3 - 1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Henry le Hamilton
.Registered No.
Place of }
Death
Winthrop & mass
Death
S
Date of
May 14"
1909
Residence
39 Orvin Street
Age
12
....
... years.
.. months .days
STATISTICAL DETAILS
SEX
male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Ucidear manie
NAME OF
FATHER
Search Namillant
BIRTHPLACE
OF FATHER+
MAIDEN NAME OF MOTHER Eliza Hanili
BIRTHPLACE OF MOTHER+ Maknem
OCCUPATION
RR browsing Flagman
INFORMANT §
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.
TILL VVI WIIN INK. - INIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from may 14 1909 to May 14 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 : Mitral Insufficione
(DURATION). DAY8
Contributory :
(DURATION) DAYS
(Signed).
Il. Parão
M.D.
Thay 15 1909 (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 ?.
PLACE OF BURIAL OR REMOVAL !! Gardner me 1
UNDERTAKER Summer Floyd
DATE OF BURIAL
.... 190.
ADDRESS
52. Theury lo. Howellon May 14 - 1909
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1909.
CITY OF BOSTON.
FULL NAME Cameron
.... Tilliam .... A
Registered No ..
45.62
Place of Death }
Boston
524 Warren st
and Residence S
Date of Death
May 15
1909.
Age
56
years
5
months
12
days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
W
S
Maiden Name
Husband's Name
Birthplace
Winchester
Name of
Father William Cameron
BOSTON
.
Contributory : 2
Heart failure -
(Duration)
Maiden Name
of Mother.
Sarah Wright
Birthplace
of Mother.
Scotland
(Signed)
F I Taylor
M.D.
May 16
1909
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1909, to 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 :
AR'S
PA
T DEL Primary ( Dura tion
Pulm Emphysema - yrs
FICE
- BOBFONIA .. CONDITA AN
16 3 D. ISREGIMINI DONATA A.
MASS.
.....
Place of Burial
or removal.
Winchester
Usual Residence
Winthrop
Filed.
May 18
1909
A true copy.
Attest :
ErMSlenen
Registrar.
1
CITY.
Birthplace
of Father
Scotland
Occupation
Insurance
Undertaker.
J O Whitney
I
Усева А. Замечал Van 15-08
[4.'07-37-LM.]
Permit No.
RETURN OF DEATH.
Winthrop BOSTON, MASS.
Date of Death, May 1,5" 190 9.
Name in full,
Elaine S. Law
(If married or divorced woman give maiden name, also name of husband.)
Sex, Female .Color,
(White, Black, Mixed, Chinese, Condition,
Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 1 Years, 11 Months, 1 Days. Occupation,
Residence, *.
Ward,
Place of Death, 135 Grovers avenue N. Highlands
Place of Birth, Haitrop Masz Date of Birth,
(State year, month and day.) ~
Name and Birthplace Į James S, Can-Woodstock I B
of Father, Maiden Name and 1 Helen HD, Maccallum St Peters DE2
1 Birthplace of Mother,
Place of Interment, ..
Drcultural, loquete Ministros, Mas
Jammer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, may 15, 1909 .
Name and Age ? Elaine ban Age, 1 years. Il wool day of Deceased,
I hereby certify that I attended deceased from. May 9, 1909, to May 15
1909 , that I last saw her alive on the. 15th day of 190 9, she
that.
died on the
day of .
1904, about. 1 . 10 o'clock
M.M., or P.M, and that, to the best of my knowledge and belief, the cause of. her death was as follows : Chief cause, Tubercular meningitis
Disease ( Contributing cause,
Duration
Chief Cause,
Contributing cause,
homme Etigot
M. D.
· If an institution, state how long an Inmate and previous residence.
,21
:
15h
May
Melanie J. lean May 15, 1909
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1909.
CITY OF BOSTON.
4691
FULL NAME Oscar L. Noble
Registered No Winthrop
Place of Death and Residence
Boston 4.Donnybrook road.
Date of Death May .17
1909.
Age
79
. years
.. months days
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
W
M
Maiden Name .
Husband's Name
....
CITY
Birthplace
Dexter .... Mich
Name of
Father
Nathanial .Noble ATIS REGUMMINR
Birthplace of Father ...
.V.t.
Maiden Name of Mother ..
Lucretia Stilson
Birthplace of Mother
N. Y ..
Occupation
None
May ... 17 . 1 909
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal
Mt . Auburn Crematorysual Residence Cambridge
Winthrop
Undertaker .
J. Waterman & Sons
Filed
May 21
1909
A true copy.
Attest :
ErMSlenen
Registrar.
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 :
ST
RAR'S
PATRIBUS SIT DE
Prima)
Pernicious Anaemia 2 yrs.
EFICE:
BOSTONIA CONDITAA.
A.182
DONATA A.
MASS. Contributory : } (Duration)
Chronic
Interstitial
Nephritis, abt 4 yrs.
(Signed)
Wm. L. Ripley
M.D.
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
MOTexim
Oscar L. Moble May 17-09
2
4
[1.'09-37-XXXM.]
Winthrop
Permit No. .....
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
May 22
1909.
Name in full, Timothy Donovan
(If married or divorced woman give maiden name, also name of husband.)
Sex, Mogle Color, White
Condition, Married.
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowcd or
Divorced.)
Age, 66 Years, 7 Months,
12 Days. Occupation,
Machinist
Residence,*
122 M am Street
Ward,.
Place of Death,
122 Main Street
Place of Birth,
Ireland
(State year, month and day.)
Date of Birth,
October 10, 1842
Name and Birthplace \ Michael Donovan - Ireland. of Father,
Maiden Name and Mary Harrington - Ireland.
Birthplace of Mother, S
Place of Interment,
Holy Cross Hoalden.
* If an institution, state how long an inmate and previous residence. m. J. Kelly Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, May 24 19.0%.
Name and Age ?
of Deceased,
Age, .. 66 years.
I hereby certify that I attended deceased from. may 1 6 1909, to.
19 Gq that I last saw - alive on the 22 the day of ..
that died on the 222 day of Imay 190%, about. non o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of
. death
was as follows : Presumony
Chief cause,
Disease 3 Contributing cause,
Chief Cause, 7 days
Duration Contributing cause,. 31 Med calf
.....
M. D.
OF PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.
21
May 22 mg
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.
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 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.
Was there organic disease of the stomach or other organs? If so, name the disease causing death.
Eclampsia.
Edema of lungs.
Gastric fever.
A worthless return. Was it acute gastritis (q. v.) or some definite form of fever, as typhoid, malarial, etc .?
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