Town of Winthrop : Record of Deaths 1910-1912, Part 2

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 2


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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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.


Name the disease causing the passive or hypostatic con- gestion.


Hypostatic congestion.


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 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.


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.


Pneumonia. Specify definitely whether broncho-pneumonia or lobar- pneumonia. If sequel to influenza, state that fact.


0


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


OscarCe Wohlschlegel


.Registered No.


126


Place of


no6 Revere " Winthrop marzo


Death *


5


Residence


706 Revered Winthrop man. Age


.. years.


45


6


Death


.. months. 19. .days


STATISTICAL DETAILS


SEX


Inale


COLOR


While


SINGLE, MARRIED, WIDOWED, OR DIVORCED


married


MAIDEN NAME t HUSBAND'S NAME t


BIRTHPLACE+


Germany


NAME OF


FATHER


Joseph wholschlegel


BIRTHPLACE


OF FATHER៛


Germany


MAIDEN NAME


OF MOTHER


Charlotte Hofferberth


BIRTHPLACE


OF MOTHER $


Germany


OCCUPATION


Ineat Critter


INFORMANT §


Ellen Kohlschlegel


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from. au


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 :


Contributory :


...


(DURATION) .. DAYS


(Signed)


M.D.


1900 .... (Address)


wonder 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


PLACE OF BURIAL OR REMOVAL II


Mordlawn Lemelerz


UNDERTAKER MAoraque


ADDRESS


296 Meridian


& Bustin Inun


BATE OF BURIAL


pelo 14th


4


190


t In case of married or divorced woman, or widow.


# State or country; also city, town or county, If known.


* 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.


§ Name and address of person giving statistical detalls. Il Name of cemetery.


Date of ¿


12Th


1960


(DURATION) DAYS


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.


Chronic


pn monia.


Com., on of


10


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, should he nissan and the sunracion "maneral


Infantile asthenia. See "Asthenia." The term "infantile" adds no precision 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 to tuberculosis, syphilis, or cholera infantum? State fully, as this return in itself is practically worthless for compilation.


Meningitis. Was it epidemic cerebro-spinal meningitis? If so, write exactly in this form Did it follow scarlet fever, pneu- monia, or some acute infection? If so, name the pri- mary disease. Was it traumatic? If so, state the nature of the violence which caused the meningitis. Was it tuberculous meningitis ?


Nephritis. Was it acute or chronic? · If acute, occurring in the course of some disease, name the disease causing death.


Old age. This is not a satisfactory return. The influence of age is shown by the statement of age in years, months, and days. To this the statement of "old age" as a cause of death adds nothing of value. Name the disease to which the old person succumbed.


Peritonitis. What was the cause of the peritonitis? "Idiopathic peri- tonitis " should be rarely returned. Was it puerperal or traumatic? In the latter case, state mode of injury.


Pernicious anemia. If any definite cause can be assigned for the anemia, it should be reported. Anemia due to tuberculosis, syph- ilis, etc., should be returned under the primary disease.


Tur. 8


Pneumonia. Specify definitely whether broncho-pneumonia or lobar- pneumonia. If sequel to influenza, state that fact.


-1


Pyemia. What caused the pyemia? Was it puerperal or trau- matic? If traumatic, state nature of accident causing injury.


Senile asthenia. See "Old age" and "Asthenia." death.


Give disease causing


Senile atrophy. See "Old age" and "Atrophy." death.


State disease causing


Senile decay. See " Old age." State disease causing death.


Senile decline. See "Old age." Name the disease, if any, that caused the decline.


Senile marasmus. See "Old age" and "Marasmus." Name disease causing death.


Shock. What caused the shock? If from injury, state nature of accident. If from surgical operation, state disease or injury requiring the operation.


Surgical


Always state the disease or injury requiring opera .... l., Unless the oneration was improner or unskilfully nor.


Do you mean septicemia, syphilis, or any other definite disease? If septicemia, what was the cause? Was it puerperal?


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.


COMMONWEALTH OF MASSACHUSETTS


Winthrop


(CITY OR TOWN.)


FULL NAME


Place of no6 Revere # Winthrop Marks


Date of ¿


Death


1


12Th


1920


Residence


706 Revere Winthrop min.


.Age


45


6


.years.


.months. 19. .days


STATISTICAL DETAILS


SEX


male


COLOR


While


SINGLE, MARRIED, WIDOWED, OR DIVORCED


married


MAIDEN NAME Ť


HUSBAND'S NAME +


BIRTHPLACEİ German


NAME OF


FATHER


Joseph sholschlegel


BIRTHPLACE OF FATHER$ Germany


MAIDEN NAME


OF MOTHER


Charlotte Hofferberth


BIRTHPLACE


OF MOTHER $


Germany


OCCUPATION


Ieat- Grotter


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from au 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.


1900 .... (Address).


Wonder mass


....


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 !!


Mondlawn Cemetery


DATE OF BURIAL


telo 14


19


0


UNDERTAKER


A Sferaque


ADDRESS


296 Freeridiant


& Bastin Inun


-


* 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.


§ Namo and address of person giving statistical detalls. I[ Name of cemetery.


ALL NAMES TO BE IN FULL


Registered No.


126


Death


RETURN OF A DEATH OscarCe Wohlschlegel


INFORMANT §


Ellen Mohlschlegel


13 Cecina Mohlschlegel Fat-12-1900


1650


ENCOREURA


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


Registered No.


Date of


Sept.22 1854.


Place of


89 Cottage Ave .. Winthrop. Mass.


Death


NAME OF HOSPITAL OR INSTITUTION, IF ANY


NO. STREET


Place of


Residence 89Cottage Ave


Winthrop Mass


NO.


STREET


CITY OR TOWN


Age


56


years 4


months. 2 days


STATISTICAL DETAILS


SEX


COLOR


SINGLE, MARRIED,


WIDOWED, OR


male


white


DIVORCED


widowed


MAIDEN NAME John Prescott


HUSBAND'S FULL NAME


BIRTHPLACE


Derryallen County Tyron. Ireland. NAME OF FATHER Thomas Prescott


BIRTHPLACE OF FATHER Ireland


MAIDEN NAME OF MOTHER Margaret Brown


BIRTHPLACE OF MOTHER England


Liquor Dealer


FULL NAME OF INFORMANT Miss Prescott (daughter)


RELATIONSHIP TO DECEASED daughter


ADDRESS


89 Cottage Ave


PLACE OF BURIAL


Cemetery


City or Town Boston


UNDERTAKER'S NAME


J.B. Cole & Son


ADDRESS


I24 Dorchester St. South Boston


NO.


STREET CITY OR TOWN


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last


illness from august 1900 ... to 74613 199/0, 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 :


Cirrhosis 1


Duration


one year


Contributory


Duration


(Signed)


M. D.


1


(Address)


wrathof


Date


+6 14 1900


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


Former or Usual Residence


How long at


Place of Death?


Days


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


Recorded


190


Clerk of Board of Health


Filed


190


City Clerk


FULL NAME


John Prescott.


Birth


Date of


Death


Feb.13 1910.


ALL NAMES TO BE IN FULL


OCCUPATION


Mt Hope


14


Fct-13-1910


ALL NAMES TO BE IN FULL


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


FULL NAME


.. .


E. Sfamilton


Registered No.


Place of Death *


30 Waldemar ave. Winthrop. Mars


Date of Death.


Auch. 17. 1910.


Age


01 years


7


months


17 days


STATISTICAL DETAILS


SEX


COLOR


W


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME Ť annie Juague -


HUSBAND'S NAME + Hung 3. Hamilton


BIRTHPLACE# Kingston, n.5.


NAME OF


FATHER


Boyd


BIRTHPLACE


OF FATHER+


IVingston nr.8-


MAIDEN NAME


OF MOTHER


matilda Messungen.


BIRTHPLACE OF . MOTHER + Kingston nail-


OCCUPATION


INFORMANT § Im. Johnstones.


PLACE OF BURIAL OR REMOVAL Mars Edson Con Lourel


DATE OF BURIAL Feb. 20 19 0)


ADDRESS


UNDERTAKER I. C. Skaggs 2 Hemon St


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from Feb


1909 .. to 19g.o ... , 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 : Pernicious Anaemia


(DURATION). ........ .. DAYS


Contributory :


(DURATION) ........ DAY8


(Signed).


A. B. Somman


M.D.


Ab. 18,


(1900 (Address)


SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.


Former or Usual Residence


How long at


Place of Death ?


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 detalis. If Name of cemetery.


15


Fat-17-1910


[1.'09-37-XXXM.]


Permit No.


RETURN OF DEATH. BOSTON, MASS. 221 Date of Death, .....


19 16.


Name in full,


I. Bugin


(If married or divorced woman give maiden name, also name of husband.)


Sex, Female Color, Shit


Condition, Vindar


(White, Black, Mixed, Chinese, Indian, etc.)


(Single, Married, Widowed or Divorced.)


Age, 6 Years, - Months, ._ Days. Occupation,


Residence,*


Ward,


Place of Death, Withwoh mass -


(State year, month and day.)


Place of Birth, Irland


Date of Birth,


Patrick Pagur - Vilaná


Name and Birthplace ! of Father,


Maiden Name and 1 mamy Saffare- Birthplace of Mother,


Sulana!


Place of Interment,


Caliano Conentrar -


* If an institution, state how long an inmate and previous residence.


I. D. Fallon


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Boston,


Feb 19'


19/0.


Name and Age anne 3 Borgin


of Deceased,


Age, 67 years.


I hereby certify that I attended deceased from. Dan 19/0 , to. Feb 18"


19 (>, that I last saw her


706 alive on the. (18" day of .. 19 / 0,


that died on the 18


day of 19 / J, about/Ups clock


A.M., or P.M., and that, to the best of my knowledge and belief, the cause of ........... .death was as follows:


Disease Chief cause, Diabetes


Contributing cause, Diabetic Lan grend


Chief Cause,


2 years


Duration


Contributing cause,


One Chrash


/ 318 met cal M. D.


OD PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.


321


The


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."


Asphyxla.


How? Was it accidental? If so, state fully the nature of the accident. If hy 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.


Was it acute bronchitis, broncho-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 by diarrhea or enteritis (infants) ? Name the disease in which the convulsions occurred. "Convulsions" are mere symptoms and should not he given as equivalent to a proper statement of cause of death.


Debility.


What caused the debility? Name the acute or chronic disease. Dehility 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.


Senile asthenia. See "Old age" and "Asthenia." Give disease causing


death.


Senile atrophy. See "Old age" and "Atrophy." death.


State disease causing


Senile decay.


See "Old age." State disease causing death.


Senile decline. See "Old age." Name the disease, if any, that caused the decline.


Senile marasmus.


See "Old age" and "Marasmus." Name disease causing death.


Shock.


What caused the shock? If from injury, state nature of accident. If from surgical operation, state disease or injury requiring the operation.


Surgical operation. Surgical shock.


Always state the disease or injury requiring operation. Unless the operation was improper or unskilfully per- formed, it should not be given as the primary cause of death.


Teething. Name the disease affecting the teething child. See "Den- tition."


Toxemia.


Was this acute or chronic poisoning due to some external agent? Was it auto-intoxication, due to poisons gen- erated in the body hy disease? If so, state the name of the disease.


Tuberculosis. State organ affected. Do not fail to state as pulmonary tuberculosis if lungs were affected.


Tumor. Was it a cancer? Whether a cancer or tumor, do not fai to specify organ or part of hody affected.


Typhoid condition.


Avoid this term as it is likely to be mistaken for typhoid fever.


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, hut, 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 precision 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 to tuberculosis, syphilis, or cholera infantum? State fully, as this return in itself is practically worthless for compilation.


Meningitis. Was it epidemic cerebro spinal meningitis? If so, write exactly in this form Did it follow scarlet fever, pneu- monia, or some acute infection? If so, name the pri- mary disease. Was it traumatic? If so, state, the nature of the violence which caused the meningitis. Was it tuberculous meningitis?


Nephritis. Was it acute or chronic? If acute, occurring in the course of some disease, name the disease causing death.


Old age.


This is not a satisfactory return. The influence of agc is shown by the statement of age in years, months, and days. To this the statement of "old age" as a cause of death adds nothing of value. Name the disease to which the old person succumbed.


Peritonitis. What was the cause of the peritonitis? "Idiopathic peri- tonitis" should be rarely returned. Was it puerperal or traumatic? In the latter case, state mode of injury.


Pernicious anemia. If any definite cause can be assigned for the anemia, it should he reported. Anemia due to tuherculosis, syph- ) ilis, etc., should he returned under the primary disease. ,


Pneumonia. Specify definitely whether broncho-pneumonia or lobar- pneumonia. If sequel to influenza, state that fact.


TEN -18-146


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 he 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" hefore 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 he so stated.


Hemorrhage of lungs.


Was this not due to pulmonary tuberculosis? If so, the primary cause should he reported without fail.


Name the disease causing the passive or hypostatic con- gestion.


Hypostatic congestion.


Imperfect nutrition.


State name of disease causing imperfect nutrition. Did it follow some disease? If so, give name of disease.


Typhoid pneumonia.


Typho-malarial fever.


Was it typhoid fever? Was it malarial fever? A mix ture of these diseases rarely occurs, the great majorit of cases of so-called "typho-malarial fever "theing noth ing more nor less than typhoid fever.


Was this not pulmonary tuberculosis?


Pyemia. What caused the pyemia? Was it puerperal or trau- matic? If traumatic, state nature of accident causing injury.


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


Elizabete aques


Shecan


Registered No.


Date of


80019


Death


Residence


291 Sheren She Will ."


6


.years.


3


.months ... 19 days


STATISTICAL DETAILS


SEX Serial


MAIDEN NAME +


HUSBAND'S NAME t


BIRTHPLACE # Boston Mars


NAME OF


FATHER


Willlan Shecan


BIRTHPLACE


OF FATHER$


bork Ireland


MAIDEN NAME


OF MOTHER


Lignes B. Magon


BIRTHPLACE


OF MOTHER #


Galway Fuland


OCCUPATION


INFORMANT § Willian Sheran gather


PLACE OF BURIAL OR REMOVAL II


DATE OF BURIAL


2/20


1986


UNDERTAKER


Ci Ri Bemusi


ADDRESS


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from 1900 Get. 19 .19@ ..... , 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 : Deporcheria


. (DURATION).


DAYS


Contributory :


(DURATION). .. DAYS


(Signed)


S.S. Partir


M.D.


the. 20


.1906 ... (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 "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 details. Il Name of cemetery.


COLOR


SINGLE, MARRIED,


WIDOWED, OR


DIVORCED


Place of 1


291 Shirley the Wundert


Death * S


17 Elizabeth agua thereau Fab- 19-1960


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


Gleason Newhall


.Registered No ..


Place of Į


Death *


5


15 Hutcherson SL


Date of


2/19


1960


Death


5


Residence


Age .68


years


months.


10


.days


STATISTICAL DETAILS


SEX,


COLOR


Muito


SINGLE, MARRIED, WIDOWED, OR DIVORCED


Manuel


MAIDEN NAME +


HUSBAND'S NAME +


BIRTHPLACE #


Lynn Man


NAME OF


FATHER


George newhall


BIRTHPLACE


OF FATHER#


MAIDEN NAME


OF MOTHER


Elizabet Naranja-


BIRTHPLACE


OF MOTHER +


Burton


OCCUPATION


INFORMANT § nife


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from. 190


.190


.... 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 :


Inumonia (Sovar)


(DURATION)


3


DAYS


Contributory :


.(DURATION).


DAY8


(Signed)


M.D.


Jeb. 21 Ministerioto


198.Q ... (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 II


Pini Gens Pensent


UNDERTAKER


ADDRESS


DATE OF BURIAL


2/22


19₫.0.


...


t In case of married or divorced woman, or widow.


* 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.


# 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


FULL NAME


18 George Gleason Newhall Fer-19-1910


...... ... ......


COMMONWEALTH OF MASSACHUSETTS.


RETURN OF A DEATH-1910.


CITY OF BOSTON.


FULL NAME


Ida J Jordan


Registered No. 1802


Place of Death ¿


Boston


New Ens. Baptist Hospt.


and Residence


Date of Death


Feb.19


1910.


Age


37


10


years months. .days.


STATISTICAL DETAILS.


SEX


COLOR


SINGLE, MARRIED, WID., DIV.


F


Maiden Name


Marsters


ST


PATRIBUS


SITO Primary: ! Phlebitis - rt.leg - 2 wks


(Duration) BIS


FFICE


Name of


Father. Joseph D' Marsters


TISREGIMIN


1634.


DONATA A.


MA S.S:


Birthplace


of Father


Windsor. I.S.


Contributory: { Pulm Embolus - 4 dys (Duration)


Maiden Name


of Mother. Eliza J Langan


Birthplace Windsor, N.S.


of Mother


Occupation Housewife


Informant


....


Place of Burial


or removal ..


St John, T. B.


Usual Residence.


Winthrop(40 Freemont st)


Filed


Feb. 25


1910.


A true copy.


Attest :


ErMSlenen


Registrar.


ANTONIS NON CHANACHY NIOHVW




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