Town of Winthrop : Record of Deaths 1910-1912, Part 13

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 13


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 (link on the Part 1 page).


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culosis of lungs, meninges, peritonacum, etc., C'arcinoma, Sar- coma, etc., of .. ..... (name origin : "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.


2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.


3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.


4. Deaths under circumstances unknown, as A person found dead, etc.


N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very


important. See instructions on back of certificate.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Wencherok Muss (No .. 24 Winchrol St. ;


(City or town.)


Ward)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


white


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH


21


(Month)


(Day)


,1901


(Year)


7 AGE


3


yrs.


mos.


3


ds.


or


min. ?


8 OCCUPATION


(a)' Trade, profession, or particular kind of work


(b) General nature of industry, business, or establishment in which employed (or employer)


9 BIRTHPLACE


(State or country)


Hastings are duIterson


10 NAME OF


FATHER


Fred Killow Wells


PARENTS


12 MAIDEN NAME OF MOTHER Margenede Jane Lowqq


13 BIRTHPLACE


OF MOTHER


(State or country)


Mormenek England


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


159 WeicheL St911cars


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


Left


2 4


191 0


(Month)


(Day)


(Year)


17


I HEREBY CERTIFY that I attended deceased from


Dep. 20


1910, to


Sep. 24


. 19110.


that I last saw her


alive on


1910.


and that death occurred, on the date stated above, at


8a. m.


The CAUSE OF DEATH* was as follows :


Cyclic Vomiting


(Duration)


yrs.


mos.


ds.


Contributory


(SECONDARY)


-


Voxarmia


. (Duration)


yrs.


mos.


4.


.ds.


(Signed)


M.D.


Sep. 26. 1916


(Address)


Minitrope, mais,


* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


of death


yrs.


mos.


In the


ds.


State ...


.yrs.


mos. .


ds.


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


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


Jeff 26


1910


20 UNDERTAKER


ADDRESS


Filed 191


1


Hundred Jellow Wells


FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 24 Werechurch Street


Registered No.


If LESS than 1 day, hrs.


11 BIRTHPLACE


OF FATHER


(State or country)


Richmond Sle


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement ; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," " Foreman," " Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal minc, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write Nonc.


Statement of cause of death. - Namc, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis ") ; Diphtheria (avoid use of "Croup ") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- eoma, etc., of .. . (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough ; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," "Old age," "Shock," "Uraemia," " Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners :


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.


2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.


3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.


4. Deaths under circumstances unknown, as A person found dead, etc.


THE COMMONWEALTH OF MASSACHUSETTS


Winthrop


(CITY OR TOWN.)


FULL NAME


Catherine Hohe


Registered No.


Place of l


Winthrop 34 Tico KANE


Death *


S


Residence


34 Dico Ave


Age


... year


15


months. 13 .days


STATISTICAL DETAILS


COLOR


SEX Female White


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME +


HUSBAND'S NAME t


BIRTHPLACE İ Boston Mass.


Walter Surplus Hohe


BIRTHPLACE OF FATHERY Cumberland Pel


MAIDEN NAME OF MOTHER Catherine Connolly.


BIRTHPLACE OF MOTHER $ Lynn Massy


OCCUPATION


INFORMANTS


Hatten & Hope


34 Dico LAVE.


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that i attended deceased during last illness, from Sent- 22 19 to Sent 26 /910, 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 : Endocarditis


Contributory :


Prenne


(DURATION). DAYS


(DURATION) 4 DAYS


(Signed) Hungryfall M.D.


Sup 26 191 (Address) 263


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


19


Clerk


PLACE OF BURIAL OR REMOVAL !?


St mary Lynn 9/28


19/0


John F. O maley 79 Atlantic st


DATE OF BURIAL


* 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.


FILL OUT WITH INK. - THIS IS A PERMANENT RECORD


ALL NAMES TO BE IN FULL


RETURN


/OF A DEATH


Date of l


Seht 26


19/0


Death


Sept. 26, 1910


3 SEX Female 6 DATE OF BIRTH 7 AGE 56 Est PARENTS important. See instructions on back of certificate. 16 N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very (b) General nature of industry, business, or establishment in which employed (or employer)


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Metcalf Hospital ...


St. ;


Ward)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


FULL NAME Hamit Shellhouse


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 21 Marion Street, Casi Boston


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


4 COLOR OR RACE


White


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Vidoro


-


(Month) (Day)


(Year)


If LESS than


day,


.hrs.


that | last saw hr


alive


191 ,


and that death occurred, on the date stated above, at 6.500 m.


The CAUSE OF DEATH* was as follows : multiple injuries, including


Skull (base, portable) molto ulting showration card lyon, Contributory accidental fall from (SECONDARY) .(Duration) yrs. a light


(Signed)


, M.D.


Sept30, 1918 (Address).


* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


of death


yrs.


mos.


In the


ds.


State


.yrs


mos.


ds.


....


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


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL Woodlawn


DATE OF BURIAL


Det 32 1910


20 UNDERTAKER


nc. g. Kelly


ADDRESS


19 11 verick f.


Filed ... 191.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


(Month)


(Day)


30, 1910


(Year)


17 I HEREBY CERTIFY that I attended deceased from


191


to


& OCCUPATION


(a) Trade, profession, or


particular kind of work


Home


-


9 BIRTHPLACE


(State or country)


Halifax n.f.


10 NAME OF


FATHER


Henry R. Bird


11 BIRTHPLACE OF FATHER (State or country) Unknown


12 MAIDEN NAME


OF MOTHER


Margaret 6, Unknown


13 BIRTHPLACE


OF MOTHER


(State or country)


Unknown


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informan


Hattie M. Stearns


(Address)


21 Marion St. 6. Barto


yrs. mos. ds.


or ..... min. ?


Harriet Bird Henry hellhouse


2791


(City or town.)


mos. . ds.


Sept. 30, 1910.


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement ; it should be used only when neoded. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return " Laborer," " Foreman," " Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer- Coal mine, etc. Women at home, who aro engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.


Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis ") ; Diphtheria (avoid use of "Croup ") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia ; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .. (name origin: "Cancer" is less definite; avoid use of " Tumor" for malignant neoplasms) ; Measles ; Whooping cough ; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old ago," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases-resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State _cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.


2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.


3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.


4. Deaths under circumstances unknown, as A person found dead, etc.


Commonwealth 0 Massachusetts


UNITED STATES OF AMERICA.


Certificate of Death


FROM THE RECORDS OF DEATHS IN THE TOWN OF


Winthrop


MASSACHUSETTS, U. S A.


1. Date of Death,


October 1 1910


Thomas J. Lavery


(Maiden Name,


3. Sex, and whether Single, Married, or Widowed, -


male


Widowed


white


4. Color,


5. Age, 77 Years Months Days


6. Disease or Cause of Death Broncho t monia following fall


7. Residence,


8. Occupation,


9. Place of Death,


Winthrop


10. Place of Birth,


11. Name of Father,


matthew


pane Elleat


(Maiden Name)


13. Birthplace of Father, -


14. Birthplace of Mother, -


15.


Place of Interment, -


-


Inst. Benedict Rox


Entalie can't. Churchill depose and say,


that I hold the office of Town Clerk of the Town of


Winthrop


County of Suffolk and Commonwealth of Massachusetts; that the records of Births. Marriages and Deaths in said Town are in my custody, and that the above is a a true extract from the Records of Deaths in said Town, as certified by me.


WITNESS my hand and the Seal of said Town, on the


eighth,


day of February 1911.


Enlahe Churchill canet. Toun Clerk.


Quer


$29.2


40 Elmwood


Retired


Landart Boslow Mass.


12. Name of Mother, -


Ireland


Ireland


2. Name,


dair .


1 93


1


nl


וה


Commonwealth of Massachusetts. Suffolk Sel. Winthrop Freh. 20, 191.


1


Then personally affeared be for any, Preston Churchelf Town Clerk, Thomas Macht Hurackhand made oath that of the place of birth of Thomas J. Javery, was Joslow and Not Freland anall that all other information in the within return is Correct


Preston B, Churchill, Join Clerk,


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Monthsof .. (No .. 40 Elemnordara; Ward)


Thomas & Javery 2 FULL NAME


{If married or divorced woman or widow give maiden name, also name of husband ] @RESIDENCE 40 Ehmerved äve.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX Male


4 COLOR OR RACE


While


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Midlerne


6 DATE OF BIRTH


Sept.


27


18歳


(Year)


(Month)


(Day)


7 AGE


If LESS than I day, .. . .. hrs.


yrs.


mos.


ds.


min.


& OCCUPATION


(a) Trade, profession, or


particular kind of work


Betina of 10 yrs.


General nature of industry, ness, or establishment in ich employed (or employer).


"IPTHPLACE


r or country)


Ireland


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


Ireland


12 MAIDEN NAME


OF MOTHER


Jane Elliot


13 BIRTHPLACE OF MOTHER (State or country) trebamal.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Thomas Machen


(Address)


40 Ellermanel One,


16


Filed. 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


Odlaten


(Month )


(Day)


19 ! O


(Year)


I HEREBY CERTIFY that I attended deceased from


Seft 28


1910 , to


, 1910


-


that I last saw h umalive on


Oct 1


, 1910.


and that death occurred, on the date stated above, at 1.30m.


The CAUSE OF DEATH* was as follows :


Bracciolo pneumonia following fall


yrs. .


mos. 12 ds.


Traumation pour tall


.(Duration)


Contributory


SECONDARY)


down stairs


(Duration)


yrs.


mos.


12 ds.


M.D.


* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.


18


LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


of death.


yrs. ..


mos.


ds.


State


In the


yrs. ..


mos.


ds.


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


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


MX Bericht Roy lect 3, 1910


20 UNDERTAKER


David Aleurton


ADDRESS


0


·


(City or town.)


{If death occurred in a hospital or institution, give its NAME instead of street and number.]


Registered No.


17


1910.


(Address).


important. See instru


10 NAME OF


FATHER


Mathew Lavery


,


(Signed)


Oct, Y, 1910


STANDARD CERTIFICATE OF DEATH.


-


Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. Bnt in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return " Laborer," " Foreman," " Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer- Coul mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.


Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis ") ; Diphtheria (avoid use of " Cronp") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sur- coma, etc., of ... (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough ; Chronic valrular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be state ?? unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," " Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," " Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," "Uraemia," "Weakness," etc. when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners :


1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.


2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.


3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.


4. Deaths under circumstances unknown, as A person found dead, etc.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


I PLACE OF DEATH


Lynn


(No.


Union Hospital.


St. ;...... Ward)


{If death occurred in a hospital or institution, give its NAME instead of street and number.]


2 FULL NAME


Hannah Griffiths


[If married or divorced woman or widow give maiden name, also name of husband.] Heaton - Thomas.


@RESIDENCE


320 Bowdoin st, Winthrop


Registered No.1 067


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


F


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


M


6 DATE OF BIRTH


Sort. 21, 1850.


(Month)


(Day)


(Year)


7 AGE


If LESS than


I day,.


hrs.


that | last saw h


alive on


, 191.


.. ,


and that death occurred, on the date stated above, at


m.


The CAUSE OF DEATH* was as follows :


Parenchymatous nephritis


(Duration)


yrs.


mos.


.ds.


Contributory.


Acute dilatation of heart


(SECONDARY)


(Duration)


yrs.


...


.mos.


ds.


(Signed)


I. H Chicoinc


M.D.


191


( Address)


Lynn


* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


of death


yrs.


In the


mos.


ds.


State


yrs.


mos.


ds ...


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


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


191


Winthrop, lass.


20 UNDERTAKER


C. R. Benneson


ADDRESS


Winthrop


important. See instructions on back of certificate.


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country}


Manchester, Eng.


12 MAIDEN NAME


OF MOTHER


Unknown


13 BIRTHPLACE


OF MOTHER


(State or country)


=


"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Thomas Griffiths


(Address)


- Winthrop Made


15 Filed ...


1911


REGISTRAR


16 DATE OF DEATH


Oct. 3, 1910


(Month)


(Day)


191


(Year)


17


0


I HEREBY CERTIFY that I attended deceased from




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