USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 25
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Disease
Contributing cause, 0
Chief Cause,
Duration Contributing cause, Frankto fillan
M. D.
PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.
521
(State year, month and day.)
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. Sce "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 ?
Asthenla. 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.
Was this not pulmonary tuberculosis?
Congestion of lungs.
.
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.
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.
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.
Was this not due to pulmonary tuberculosis? If so, the primary cause should be reported without fail.
Hypostatic congestion.
Name the disease causing the passive or hypostatic con- gestion.
Imperfect nutrition.
State name of disease causing imperfect nutrition. Did it follow some disease? If so, give name of disease.
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 preci to an indefinite statement.
Infantile atrophy. Sce "Atrophy."
Malassimilation. What disease caused the malassimilation ?
Malnutrition. What disease caused the malnutrition ?
Marasmus. What disease caused the "marasmus" ? Was it du tuberculosis, syphilis, or cholcra infantum? S fully, as this return in itself is practically worthless compilation.
Meningitis. Was it epidemic cerebro-spinal meningitis? If so, exactly in this form. Did it follow scarlet fever, p monia, or some acute infection? If so, name the mary disease. Was it traumatic? If so, state nature of the violence which caused the mening Was it tuberculous meningitis?
Nephritis.
Was it acute or chronic? If acute, occurring in the co 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 tonitis" should be rarely returned. Was it puerp or traumatic? In the latter case, state mode of inju
Pernicious anemia. If any definite cause can be assigned for the anemia should be reported. Anemia due to tuberculosisasy ilis, etc., should be returned under the primary dige
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 matic? If traumatic, state nature of accident cau injury.
Senile asthenia. See "Old age" and "Asthenia." Give disease caus
death.
Senile atrophy. See "Old age" and "Atrophy." death.
State disease cau
Senile decay. See "Old age." State disease causing death.
Senile decline.
See "Old age." Name the disease, if any, that caused
decline.
Senile marasmus.
See "Old age" and "Marasmus." Name disease caus
death.
Shock. What caused the shock? If from injury, state natur accident. If from surgical operation, state dise 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 cau- death.
Teething. Name the disease affecting the teething child. See" tition."
Toxcmia. Was this acute or chronic poisoning due to some exter agent? Was it auto-intoxication, due to poisons erated in the body by disease? If so, state the m of the disease.
Tuberculosis. State organ affected. Do not fail to state as pulmor tuberculosis if lungs were affected.
Tumor. Was it a cancer? Whether a cancer or tumor, do not to specify organ or part of body affected.
Typhoid condition. Avoid this term as it is likely to be mistaken for typ fever.
Typhoid pneumonia.
Typho-malarial fever.
Was it typhoid fever? Was it malarial fever? A ture of these diseases rarely occurs, the great majd of cases of so-called "typho-malarial fever" being D ing more nor less than typhoid fever.
Was the primary disease typhoid fever or pneumonia ?
Inanition.
Was it acute bronchitis, broncho-pneumonia, or lobar- pneumonia? If so, state definitely. Was it passive or hypostatic congestion ? If so, name disease causing
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Sarah A Corcoran
Registered No.
15
Date of l
July.
22
.1909
45 years.
.. months
........ .. days
STATISTICAL DETAILS
SEX
Firm
COLOR
Mute
CINOLE, MARRIED,
DIVORCED
MAIDEN NAME Ť
Sarah A. Fleming
HUSBAND'S NAME t
Daniel Corcoran
BIRTHPLACE #
Ireland
NAME OF
FATHER
James Fleming
BIRTHPLACE
OF FATHER#
Ireland
MAIDEN NAME
OF MOTHER
Ellen Beckford
BIRTHPLACE
OF MOTHER #
Ireland
OCCUPATION Housewife
INFORMANT §
Husband
PLACE OF BURIAL OR REMOVAL II
St Josephis Cem
Treat Rox bury Mass
DATE OF BURIAL
July 24
1909
UNDERTAKER
Frank S. Maloney
ADDRESS
123MarcrickSA
East Boston
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from. May 17 1909 to. July 22 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 :
Pulmonary Interculos is
.(DURATION).
1 yr
... DAYS
Contributory :
(DURATION).
.DAY8
(Signęd)
Halter A. Griffin
M.D.
1/23
190. ... (Address).
Sharon
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death ?
. years
months.
Where was disease contracted,
If not at place of death ?
Filed
July 29
1909
George H. Whitemore
Copy attest
Jour 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.
Registrar.
Place of l
Pine Crest Sharon Mass
Death * S
Residence
63 Hutchinson St. Winthrop A
Death
Sharon
....... days
Sarah a. Concarou July 22 -09
٨٠٠٢٧٢٥٪
1
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1909.
CITY OF BOSTON.
FULL NAME
elah Archer
Registered No 6396
Place of Death )
Boston
-.... Deaconess Hospt
and Residence S
Date of Death
Jul. 24
1909.
Age
56
years
months. days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
I.I
Maiden Name
Collins
Charles Archer
Husband's Name
Birthplace
Westport, I.S.
Name of
Father.
Collins
Birthplace
of Father
Maiden Name
Hannah Harris
of Mother
Birthplace
Yarmouth, I.S.
of Mother
Occupation
Housewife
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 :
RAR'S
ATRIBUS SIT DEU
CITY.
SK
UT Primais (Dura from)
Intestinal obstruction -
4 days
.BOSTONIA. .182
CTVTTATIS CONDITA AD. ISREGIMINE DONATA A. BOSTO 183D.
MASS.
Contributory : 2
Laparotomy - 20 hrs
(Duration)
D F Jones
(Signed)
M.D.
Jul. 25
1909
....
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial
or removal
Winthrop
Usual Residence
Winthrop
Jul 26
Filed.
1909.
A true copy.
Attest :
ENMSlenen
Registrar.
Undertaker ..
Surmer Floyd
...
Lelah archer. July 24-'09
e
Ext
ns
el
no
i3
A
a
[1-'09-37-XXXM.]
Permit No.
RETURN OF DEATH.
Dintrafo
BOSTON, MASS.
Date of Death,
July 24" 1909.
(If married or divorced woman give maiden name, also name of husband.)
Sex, female Color, Ophile
Condition, .:
Widowed
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowcd or
Divorced.)
Age, 86 Years, 4 Months, 12 Days. Occupation,
Residence,*
Printtuap Mask
Wordt,.
Place of Death,
144 Laring Road (Cal Pank)
Place of Birth,
London England Date of Birth,
(State year, month and day.)
Name and Birthplace
John Glenny = Yorkshire England
of Father,
Maiden Name and" Mary Ray
Birthplace of Mother,
Place of Interment,
* If an institution, state how long an inmate and previous residence. Dummer Floyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
19.09.
Name and Age ? Mary Stenia
Age, 5 6 years.
of Deceased,
I hereby certify that I attended deceased from.
1909, that I last saw
alive on the 2417
day of. Jul 190%,
that. the died on the. 241k day of Jue 1909, about. 7 o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of
Chief cause, Aprofentry ....
Disease
Contributing cause, ... Age
Chief Cause,. .....
Duration Contributing cause,. A. B. Dorman
M. D.
PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.
( 1909, to July 24th
her death was as follows :
Name in full, Mary Steny
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.
Was this not pulmonary tuberculosis?
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.
Debility.
Dentkion.
Dropsy.
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.
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.
Was this not due to pulmonary tuberculosis? If so, the primary cause should be reported without fail.
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 typh 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 precisi to an indefinite statement.
Infantile atrophy. See "Atrophy."
Malassimilation.
What disease caused the malassimilation ?
Malnutrition. What disease caused the malnutrition ?
Marasmus. What discase 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, pne monia, or some acute infection? If so, name the p mary disease. Was it traumatic? If so, state nature of the violence which caused the meningit 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 agc. This is not a satisfactory return. The influence of age shown by the statement of age in years, months, a 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 pc 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. Anemia due to tuberculosis, syp ilis, etc., should be returned under the primary diseas
Pneumonia. Specify definitely whether broncho-pneumonia or lob 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 operatic Unless the operation was improper or unskilfully pi 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 exteri agent ? Was it auto-intoxication, due to poisons ge erated in the body by disease? If so, state the nal of the disease.
Hypostatic congestion.
Name the disease causing the passive or hypostatic con- gestion.
Imperfect nutrition.
State name of disease causing imperfect nutrition. Did it follow some disease? If so, give name of disease.
Typho-malarial fever.
Was it typhoid fever? Was it malarial fever? A m ture of these diseases rarely occurs, the great major of cases of so-called " typho-malarial fever " being no ing more nor less than typhoid fever.
may Henry
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.
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.
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.
Name the disease in which the "dropsy" occurred.
f
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
....
(CITY OR TOWN.)
_
Registered No ....
Place of 124
Death *.
5
Residence
Age
.years
04
.months. .days
STATISTICAL DETAILS
SEX
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE#
Brooklyn 2.4
NAME OF FATHER Curtes Bolton Lowered
BIRTHPLACE
OF FATHER$
new York City
MAIDEN NAME
OF MOTHER
Elizabet Wright
BIRTHPLACE OF MOTHER # Flushing Kong Island
OCCUPATION
INFORMANT §
Liste Des. R. E. Mc Connell
PLACE OF BURIAL OR REMOVAL II
Greenwood Brooklyn 2. 7.
DATE OF BURIAL
7/zó
190 .. 9.
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that ! attended deceased during last illness, from July / 1909 to July 28 199 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 : Chronic Valvula
Primary :
Heart Disease
Several years
.DAYS
Contributory :
Cerebral apublicy
14
(DURATION).
.DAY8
(Signed)
July 28 1909 (Address)
.M.D.
Mittwoch mass
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. 1 State or country ; also clty, town or county, if known.
§ Name and address of person giving statisticai details. Il Name of cemetery.
190 9
Death
Date of l July 28
FULL NAME
Elizabeth Lowene
83 Elizabeth Lomane July 28-09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Flora. Caldwell Wilson
FULL NAME.
Place of
43 Taft are
Death *
5
Residence
Age
years.
6
a
.months.
.days
STATISTICAL DETAILS
SEX
7's male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
Flora Caldwell.
HUSBAND'S NAME +
wilson
BIRTHPLACE # Glascon Scollant
NAME OF FATHER John Caldwell
BIRTHPLACE OF FATHER$ Feland
MAIDEN NAME
OF MOTHER
Kuchenne Mc Fadgen
BIRTHPLACE
OF MOTHER #
Scotland
OCCUPATION
INFORMANT § Sam James Wilson
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
190 .. 7
UNDERTAKER
C. R. Bennison
ADDRESS
Winchno.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from June 1 1909 to July 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 :
Cerebral Upoplety
4 months Formation DAYS
Contributory :
Chronic Volumea
Heart Disease
(OURATION)
(Signed)
.M.D.
lug 2 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 ?.
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.
1 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
Wirths of Mas (CITY OR TOWN.)
Registered No.
Date of l
Lunes 31
190 S
Death S
8.7 Flora Goldweek thiem July $1.09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH James. G. Crichton
Wichwoli (CITY OR TOWN.)
FULL NAME
Death *
S
Place of )
Metrael Horhetat
Date of ¿
Death
612
1909
Residence
105 Habenoud Sit.
Age
62
. years.
months .days Cambridge Man
STATISTICAL DETAILS
SEX
Male
COLOR
Mute
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Marcel
MAIDEN NAME t HUSBAND'S NAME t
BIRTHPLACE #
Halifax n.S
NAME OF
FATHER
Geo. a. S. Crichton-
BIRTHPLACE
OF FATHER#
Halifax n.5
MAIDEN NAME
OF MOTHER
Jaunais Sarah Roche
BIRTHPLACE
OF MOTHER+
Degly M. St.
OCCUPATION
Barkeiten
INFORMANT §
1
Philif. S. Buchlow
PHYSICIAN'S CERTIFICATE
1
190 ..
.to
HEREBY CERTIFY that I attended deceased during last
illness, from
aml
any 12
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 :
Stran coluted
Inguinal Hernia
Cutil Inger
.(DURATION).
10
.. DAY8
Contributory :
operation
(DURATION)
6
DAY8
(Signed)
Blmetcalf
M.D.
Cham /200
1909 (Address)
174 hourtetst
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
bday
Place of Death ?
fears.
months.
days
Where was disease contracted,
If not at place of death ?
TempleGir lanthiop
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 detalls. Il Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Cambridge Come Clay 15#
190.C
UNDERTAKER GR. Person
ADDRESS
Registered No.
86. 85 James a. berichtions aug 12-1909
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1909.
CITY OF BOSTON.
FULL NAME
John Jacobs
Registered No.
7014
Place of Death }
Boston
Mass. Gon, Hosp
and Residence S
Date of Death
Aug 13
1909.
Age
48
. years ..
months .. .days.
STATISTICAL DETAILS.
PHYSICIAN'S CERTIFICATE.
t
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
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 :
Maiden Name.
ST
RAR'S
Malignant Lymphoma of .
Husband's Name
CITY
FFICE
Intestine
Name of
Father Michael Jacobs
ISREGIMINE
MAS.S.
Birthplace
of Father
Germany
Contributory : ( (Duration)
.
Maiden Name
of Mother ..
Zella
Birthplace
Germany
of Mother
M.D.
Aus 14
1909
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Admitted to Hosp. Aug. 5,1909
Place of Burial
or removal.
New York N. Y.
Usual Residence.
"Winthrop"76 Sunnyside Av.
Au~ 17
Filed .
1909
A true copy.
Attest :
ENMSlenen
Registrar.
MARGIN RESERVED FOR BINDING.
9
Birthplace
Tarrytown II Y
BOSTONIA A. 1822
CONDITAA
183D.
DONATA A.
10 mos.
9
(Signed).
Carleton R. Metcalf
Occupation
Tailor
Informant
Undertaker
Jos L Burke
R DATRIBUA SIEDERE BOY (Duration)
BOSTON
Solen Jacobs. Chung 12-1909-
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Baby
Tham
Registered No.
Place of )
15 Pleasant Park Road
Date of
Death
5
aug 23-
190
Death *
S
Residence
Age
.. years
months. .days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Hunwhich Mass.
NAME OF
FATHER
Hugh 4.
BIRTHPLACE OF FATHER Lajunta @al.
MAIDEN NAME OF MOTHER Mary I arnaud
BIRTHPLACE OF MOTHER Everett Mas.
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