USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 2
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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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