USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 30
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§ Name and address of person giving statistical detalls. || Name of cemetery.
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
1
>
UNDERTAKER
ADDRESS
. 190 .....
Registered No ..
Date of ¿
Y
Death
S
190 q
varam
stilliam Df. Sugraham. Дил 16-19 09
[1.'09-37-XXXM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, December And, 1909
Name in full, Carl tackke
(If married or divorced woman give maiden name, also name of husband.)
Sex, Tale. Color, Thite.
Condition, Married.
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 28. Years, 11 Months, Days. Occupation, Soldier ( Cp1. 7. Co.
Residence,* C. S. Army, Fort Banks
Mass. Ward,
Place of Death, Post Hospital, Fort Banks, Dass.
(State year, month and day.)
Place of Birth, Lev Haver, Corn.
Date of Birth,
jec. 29, 2080.
Name and Birthplace ? Trtrorm.
.
..... of Father,
Maiden Name and .בת ס:'מ'
Birthplace of Mother,
Place of Interment, Hinttrofe com
* If an institution, state how long an inmate and previous residence. H.C. Skagen. 10
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Tort Benka. Kass .. Dec. Ctrl.
Boston,
19 09
Name and Age Car Macko. Corporal. 7. Co. , C.A. C., Age, 23 years. of Deceased,
I hereby certify that I attended deceased from .. Dec. 19th, 1909 to Dec. Name,
19 09, that I last saw hin alive on the ... 22na day of. December, 1909
that died on the day of .. December, 199 , about10. 20 o'clock
A.M .; or. P. M., and that, to the best of my knowledge and belief, the cause of his death was as follows:
Chief cause, Hortio Insuffici no).
Disease
Contributing cause,
Dilatation of the Heart.
Chief Cause, ..
Duration Contributing cause,
...
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 causc. 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, hroncho-pneumonia, or lohar- 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 hy 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 he 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 agc 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 he avoided. "General paralysis" should he 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. follow some disease? If so, give name of disease.
Did it
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.
Infantlle asthenia. See " Asthenia." The term "infantile" adds no preci 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 du tuberculosis, syphilis, or cholera infantum? S fully, as this return in itself is practically worthless compilation.
Meningitis. Was it epidemic cerebro-spinal meningitis? If so, w exactly in this form. Did it follow scarlet fever, pr 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 succumhed.
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 inju
Pernicious anemia. If any definite cause can he assigned for the anemia should be reported. Anemia due to tuberculosis, sy ilis, etc., should he returned under the primary dise
Pneumonia. Specify definitely whether hroncho-pneumonia or lol pneumonia. If sequel to influenza, state that fact
Pyemia. What caused the pyemia? Was it puerperal or tr matic? If traumatic, state nature of accident caus injury.
Senile asthenia. See "Old age" and "Asthenia." death.
Give disease caus
Senile atrophy. See "Old age" and "Atrophy." death.
State disease caus
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 nature accident. If from surgical operation, state disease injury requiring the operation.
Surgical
operation.
Surgical shock.
Always state the disease or injury requiring operati Unless the operation was improper or unskilfully I formed, it should not he given as the primary cause death.
Tecthing. Name the disease affecting the teething child. See "D tition."
Toxemia. Was this acute or chronic poisoning due to some exter agent? Was it auto-intoxication, due to poisons g erated in the hody hy disease? If so, state the na of the disease.
Tuberculosis. State organ affected. Do not fail to state as pulmon tuberculosis if lungs were affected.
Tumor. Was it a cancer? Whether a cancer or tumor, do not to specify organ or part of hody 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 ?
Typho-malarial fever.
Was it typhoid fever? Was it malarial fever? A n 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.
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1909.
CITY OF BOSTON.
FULL NAME James C Stover
Registered No.
10945
City Hospt
and Residence S
Dec.29
69
8
3
Date of Death
1909.
Age
. years
months.
days.
STATISTICAL DETAILS.
PHYSICIAN'S CERTIFICATE.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
W
M
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 :
Maiden Name
ST
AR'
IBUS SITDE
PATRIE
Primacy (Dura Bon)
Pneumonia, Frac. Femur, accidental
fall
Birthplace
Harrison Me
Name of
Daniel Stover
TSREC
TMIN
DONATA AN
. MA'S S.
Birthplace
Limerick, Me.
of Father
Maiden Name Betsy Clark
of Mother
Birthplace of Mother.
Naples, Le.
Engineer (Locomotive)
Occupation
Informant
Place of Burial
or removal
Winthrop "Winthrop Cem"
Undertaker C R Bennison
Winthrop
Usual Residence
Winthrop
File
Jan . 1, 1910
1909.
A true copy.
Attest :
EuMElenen
3
-
st
. .
S :
Y
.....
TYTTAT
CONDITAA
18 81.
BOSTON
Contributory : (Duration)
(Signed)
G B Magrath, Med. Ex
M.D.
1909
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
r
Registrar.
Y
Father
BOSTONTA" A. 1822
FICE
Husband's Name
CITY
I HEREBY CERTIFY that I attended deceased during last illness,
Place of Death }
Boston
mitchell Browsing Dec. 31-1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Jarah. E. Bennett
FULL NAME
Place of l
Death *
..
Residence
60 Sea Vuci ama
Age
36
.years.
>
months. 20 .days
STATISTICAL DETAILS
SEX Terecola
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE #
NAME OF FATHER francis Ford
BIRTHPLACE
OF FATHER$
MAIDEN NAME
OF MOTHER
may. i Granger
BIRTHPLACE OF MOTHER$
OCCUPATION
INFORMANT § Husband
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Dec 25 plus 31" 1909, 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 :
Primary :
Pneu monia
(DURATION), .. 7 DAYS
Contributory :
(Signed)
31 metral
(DURATION). . DAYS
Dec 3/ 1909.
(Address)
Worthop.
M.D.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, 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
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
1/3
1980
UNDERTAKER
ADDRESS Wmitt
* 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, 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 details. Il Name of cemetery.
ALL NAMES TO BE IN FULL
Wathot ...
(CITY OR TOWN.)
Registered No.
Date of l
Dec 31
.190 9
Death
1
126 Sarah E. Barrett
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