USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 3
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PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from
1910, to
.1910, 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:
AR'S
Husband's Name
Maynard H Jordan
ITY
Birthplace
St John, N. B.
TVITATI
BOSTONIA
CONDITA A.
A. 1822.
(Signed)
H W Goodall
..... .M.D.
Feb .... 1.9. 1910
....
....
SPECIAL INFORMATION from Hospitals, Institutions, Transier.ts, or Recent Residents.
Undertaker
C R Bennison
Winthrop .
N
19 Мелкие дж.живелений Экв 20-1910
it should not haricinde the primary savona
forma
non the primary
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Henderson
(CITY OR TOWN.)
FULL NAME
Place of l
Death *
Residence
#15 Giorno ant
Age.
.years ..
.months. days
STATISTICAL DETAILS
SEX female
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
NAME OF
FATHER
Franklin: a. Henderson
BIRTHPLACE
OF FATHER$
MAIDEN NAME
OF MOTHER
Eleanore. M. Moore
BIRTHPLACE
OF MOTHER #
Towarto out.
OCCUPATION
INFORMANT § Franklin. & Henderson
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
2/23
1960
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Sub. 19 190.0 ... to 2125 .196.6 .. , 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 : Peratura
Contributory :
(DURATION). .DAYS
(Signed)
(3. Hel ius
1
M.D.
26.23
190.0 ... (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.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalis. Il Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Registered No.
Date of Į
2/21
196 ℃
Death
1
(DURATION). .. DAYS
20
Henderson on Feb 21-1910
Farma
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Than I. Jordan
.. Registered No. ..........
Place of Death *
HO Hundont St Huittore Haus.
Date of Death
tek. 22-1910.
Age
81 years
8 months
2 days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť mary L. Rud
HUSBAND'S NAME + David Gordon
BIRTHPLACE # Boothbay Marine
NAME OF FATHER
BIRTHPLACE
OF FATHER+
Boothbay Is.
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER +
OCCUPATION
INFORMANT § Than nard H. Jordan.
PLACE OF BURIAL OR REMOVAL II Boothbay ME
DATE OF BURIAL 2-25 1900
UNDERTAKER
H.C. S rugas.
ADDRESS 2 Harmony
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jack. 16 1960 to Jef. 22 190.2.4 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 : Miture Regurgitation
auchma
Contributory : .. Indep.
(DURATION). DAYS
(Signed) Dr.g. Partes M.D.
Ich. 23 190 .. Q. (Address)
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 ?
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 detalls. || Name of cemetery.
ALL NAMES TO BE IN FULL
. (DURATION). ... DAYS
21 Mary D. Jordan. Tel. 22-1910
DAL na MARA on those macunalla
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1910.
CITY OF BOSTON.
FULL NAME
Samuel White
Registered No.
1886
Place of Death ¿
Boston
Mass. Homeo. Hospt.
and Residence S
Date of Death.
Feb. 24
1910.
Age
years
.months ... .days.
STATISTICAL DETAILS.
SEX
COLOR
M
W
SINGLE, MARRIED, WID., DIV. S
Maiden Name
Husband's Name
Boston
Birthplace
Name of
Father
Charles White
GIVITAT
BOSTONIA CONDITA A.
A.1822
Birthplace
of Father
Contributory : (
(Duration)
Maiden Name
Etta Swame
of Mother
Birthplace of Mother
Russia
J A Hayward
.M.D.
Feb.24
1910
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial
Woburn"Knights of liberty"
or removal.
Undertaker Jacob Stanotsky
Usual Residence
Winthrop(6 Waveway ave)
Filed
Feb.26
1910.
A true copy.
Attest :
ErMSlenen
Registrar.
MARGIN RESERVED FOR BINDING.
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from. 1910, to. 1910, 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:
ST
RAR'S
T PATRIBUS SIT DE
Lobar Pneumonia
Primacy (Duration) FFICE!
TISREGIMINE
18 30.
DONATA A.
Russia
BOSTON
MAS.S.
Scarlet fever - 6 days
(Signed)
Occupation.
Informant
CITY
3
70 ΜΠΑΤ 4Η
F
COMMONWEALTH OF MASSACHUSETTS
239
1
Winthrop
(CITY OR TOWN.)
FULL NAME
Serge K.
nuttall
!
.Registered No.
Date of l
Ich 24
.1980
Death S
Death *
5
Residence
4
.Age
65
.. years. ٠٦
.... months ...................... days
med Examinar
PHYSICIAN'S CERTIFICATE
SEX
Male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Manuel
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
Jobens M.B.
NAME OF FATHER William Nuttall .
BIRTHPLACE OF FATHER+
Halofor U.S.
MAIDEN NAME OF MOTHER Rebecca. Handan
BIRTHPLACE
OF MOTHER
If Johns n.B.
OCCUPATION
wilder
INFORMANT § wife
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. Il Name of cemetery.
PLACE OF BURIAL OR REMOVAL II
1
Glenwood Prevention
DATE OF BURIAL
frex 27
196.0
ADDRESS
UNDERTAKER CRBenquoi
| HEREBY CERTIFY that + attended deceased during last illness, from 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 :
Poisoning by opium
(laudanum)
Suicidal
(DURATION) .. DAYS
Contributory :
(Signed)
Serge Burger brug
.(DURATION). ........ DAY8
M.D.
190. (Address) Medina
Sifolklo.
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 ?
: 4
ALL NAMES TO BE IN FULL
RETURN OF A DEATH
Place of )
50 Main St.
STATISTICAL DETAILS
22
George 11. Hultall Feb- 24-1910 -
wwwanna the primary house of
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1910.
CITY OF BOSTON.
FULL NAME
Oscar G Berry
......
Registered No.
1913
Place of Death }
Boston
Eliot Hospt.
and Residence S
Date of Death
Feb. 25
1910.
Age.
45
years
6
months.
16 days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
I HEREBY CERTIFY that I attended deceased during last illness,
.1910,
from 1910, 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:
RAR'S
PATRIBUS SITO
Primary: ) Porf. Duodenal ulcer - 9 dys
(Duration) EFIC E:
.... ........
.....
Name of
Father Marcellus D Berry
Birthplace of Father Bradford, Vt.
Maiden Name
Hannah A Evans
of Mother
Birthplace of Mother. Reading
(Signed) ................ M.J.Mixter ...... M.D.
Feb.25
....
.......
SPECIAL INFORMATION from Hospitals, Institutions, Transier.ts, or Recent Residents.
Informant.
......
Place of Burial
or removal.
Lynn
Usual Residence
Winthrop(68 Washington
St)
Feb. 28
Filed
1910.
Undertaker
W C Skaggs
.inthrop
PHYSICIAN'S CERTIFICATE.
Maiden Name -...
Husband's Name
Birthplace Reading
CITY
BOSTONIA CONDITAA
TISREGIMIT
ST
N
YATA A.1822
MAS.S. Contributory : ( Peritonitis - 9 days
(Duration)
Occupation. ...... Insurance
1910
A true copy. Attest : ErMSlenen
Registrar.
מנים
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Mary Ellen Lerle
Registered No ..
Date of ¿
2/21
1910
Death
>5
6
months
15
.days
STATISTICAL DETAILS
SEX Female
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
circon
MAIDEN NAME +
Wallace
HUSBAND'S NAME 1
Kev. Samuel. R. bitte
BIRTHPLACE# Mount Stealing Kunhuty
NAME OF
FATHER
Frugt. J. Wallace
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER Marquette Romana
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT § Miks. S. S. Whiting
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL 3/1 1960
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 2023 190 .....
07/27/980 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 : Promomed
(DURATION)
DAYS
Contributory :
(OURATION). DAYS
(Signed)
74 28 ,00.
(Address).
M.D.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Piace 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. # State or country; also city, town or county, if known.
§ Name and address of person giving statisticai details. ][ Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Place of l
40 Plummer SL
Death *
Residence
Cc
C-
Age
.years.
23 mary Ellen Little File. 27-1910.
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1910.
CITY OF BOSTON.
FULL NAME
Bertha Waity Scott
Registered No. 2047
Lass. Gen . Hospt.
Place of Death }
Boston
and Residence S
Mar. 1
39
3
19
Date of Death
1910.
Age
- years
.months.
.days.
STATISTICAL DETAILS.
SEX
COLOR
F
W
SINGLE, MARRIED, WID., DIV. S
Maiden Name
Husband's Name
Birthplace Woonsocket, R.I.
Name of
Father Edwin R Scott
Birthplace
of Father Blackstone
Maiden Name
Henrietta Abbott
of Mother
Birthplace England
of Mother
Occupation
Manicurist
Informant
......
Place of Burial
or removal
Woonsocket, R.I.
Undertaker
JA C Wightman
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
1910, from 1910, 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:
ST
IT PATRIBUS
SITDE :Primaoy (Duration)
Gen . Poritonitis - 3 dys
SEFICE;
VITA
BOSTONIA CONDITA AD.
A.1822
DONATA A
Contributory : 3
Appendicitis - 6 mos
(Duration)
(Signed)
C R Motcalf
.M.D.
Mar.1
1910
SPECIAL INFORMATION from Hospitals, Institutions, Transier.ts, or Recent Residents.
Admitted to hospital Fob. 24,1910
Usual Residence.
Winthrop(15 Moore st)
Mar.3
Filed.
1910.
A true copy.
Attest :
Ermslenen
Registrar.
MARGIN RESERVED FOR BINDING.
183D. ISREGISSENE BOSTON. MAS.S.
RAR'S
CITY
COMMONWEALTH OF MASSACHUSETTS
1
2
Willnot. (CITY OR TOWNA
RETURN OF A DEATH
FULL NAME
Marianna Butieri Cristofori
Registered No.
Place of l
Death *
5
meliael Hospital
Residence
mars
Age
.. years ..
.. months. .. days
meli eramis
PHYSICIAN'S CERTIFICATE
SEX Female
COLOR
Wleite
SINGLE, MARRIED, WIDOWED, OR DIVORCED
widow
MAIDEN NAME +
mariana Butices
HUSBAND'S NAME +
Minghi Cristofori
BIRTHPLACE +
NAME OF
FATHER
BIRTHPLACE
OF FATHER$
Italy
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER +
OCCUPATION
Servant
INFORMANT § alfloriano. Picana!
I HEREBY CERTIFY that I attended deceased during last
Fitness, from
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 :
multiple burno o
12x, ad x 3d digans
0
ofacci dental org (DURATION)
DAY8
Contributory :
(DURATION).
.. DAY8
(Signed)
Junge Burgon Manuel
M.D.
.190
.(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
* Clty 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 statisticai details. 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 Plymancato
DATE OF BURIAL
Mar qIX
19g.a.
UNDERTAKER
ADDRESS Kulturof
Death
Date of l
mar 2 08
190 ℃
STATISTICAL DETAILS
2.5 mariana Butieri Cristofori man . 7-1910
[1-'09-37-XXXM.]
Winthrop mass
Permit No.
RETURN OF DEATH. BOSTON MASS.
the
Date of Death,.
marsh ?? 19 Q
Name in full, maria.
Henderson Dryfo Drieciam (If married or divorced woman give maiden name, also name of husband.)
Sex, Females Color, Soluté
Condition,
Stidlow
(Single, Married, Widowed or Divorced.)
Age, 80 Years, Years, Months, .. Days. Occupation,
(White, Black, Mixed, Chinese, Indian, etc.) Certomé
Residence, *
Daunbar CE
Ward,
Place of Death, 2 Familiar CE
Place of Birth,
Ireland Date of Birth,.
(State year, month and day.)
Name and Birthplace ) not shown
... of Father, Maiden Name and 1
Birthplace of Mother, Salvarat EnElEry- Bastão Place of Interment,
* If an institution, state how long an inmate and previous residence.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, ..
Mar. 9
19/0
Name and Age ? Maria J, Henderson
Age, 85 years.
I hereby certify that I attended deceased from. apr. 1909, to mar 5
19/0 , that I last saw lier alive on the fifth
day of. 19/0,
that died on the Dereult day of luar.
1910, about-o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. . .. death
was as follows : Qlironie interstitial repliritis
Disease ? Chief cause,
Contributing cause,. Gangrene of the
Duration
Chief Cause, Cine year
Contributing cause, Two weeks
Edward . Tranger - M. D.
PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.
of Deceased,
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 Was it disease? If septicemia, what was the cause? puerperal ?
Chronic~ pneumonia.
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.
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. follow some disease? If so, give name of disease.
Did it
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 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.
Pneumonia.
Specify definitely whether broncho-pneumonia or lobar-
pneumonia. If sequel to influenza, state that fact.
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." State disease causing
death.
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.
B
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 by 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 fail
to specify organ or part of body affected.
Typhoid condition.
Avoid this term as it is likely to be mistaken for typhoid
fever.
Was the primary disease typhoid fever or pneumonia ?
Typhoid pneumonia. Typho-malarial fever. Was it typhoid fever? Was it malarial fever? A mix- ture of these diseases rarely occurs, the great majority of cases of so-called "typho-malarial fever " being noth- ing more nor less than typhoid fever.
Inanition.
Was this not pulmonary tuberculosis?
UNDERTAKER'S RETURN
of Wrathof
To the Board of Health of the City of Worcester
Date of Death
March 8
Name Denise Pourtue
Maiden Name.
Sex
Color
Married, Single or Widowed
Age
65
Years
Months
Days.
Name of the Physician
Whether 56 2.
Residence of the Deceased, No ..... 21
[{2 }- WinStreet
Occupation
Husband's Name.
Place of Death, No.
Place of Birth
Father's Name
Father's Birthplace.
Mother's Maiden Name
Birge
Mother's Birthplace
Place of Interment
Date of Burial
ничего 10
Information given by -
Signature of Undertaker
Dated at Worcester, this.
10 cts
day of.
quar
19/0
Physician's Certificate of the Cause of Death.
Date of Death,
March 8.
1910,
Name and Sex of Deceased,
Place of Death
Disease or
Primary
No. 20 Nafatura Do Manchego many Initial Regurgitateon)
Duration of*
Cause of Death
Contributory
Epicpay
Duration of
Uncertain
I certify that the above is a true Return, to the best of my recollection and belief.
Name and Professional Title, . d-4. Vorce?
Street Marchisep, 200xx.
Residence, No. 5Gr
Dated at Worcester, this.
0
day of Mark
19 /".
[ Be very particular to fill all the Blanks.]
* Reckoned to the time of death.
Approved,
Board of Health.
Daniel Donahue
Cemetery
May 8 - 1910
Daniel Douche
the cause should be given and the expression "general
Unless the operation was improper or unskilfully
1
operation.
1. 1 . 40 ----- 1
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1910.
CITY OF BOSTON.
2294
Registered No.
Place of Death ¿
Boston
Boothby Hospt.
and Residence S
Date of Death
Mar. 9
1910.
Age
35
3
. months
13
.days.
STATISTICAL DETAILS.
SEX
COLOR
F
SINGLE, MARRIED, WID., DIV. I.I
I HEREBY CERTIFY that I attended deceased during last illness,
from 1910, to .. 1910, 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
Folsom
John & Thompson
Husband's Name
Carmel, Me.
Birthplace
Name of
Oliver J Folsom
Father.
Birthplace Blue Hill, Me.
of Father
Maiden Name Elizabeth A Clapham
of Mother
Carmel , LIo.
Birthplace of Mother.
Occupation
iTone
Informant
......
Place of Burial
Epring, T.H.
or removal.
Undertaker AT Lastman .Co.
PHYSICIAN'S CERTIFICATE.
PATRIBU
Primacy (Duration)
Post-Opr. shock - 20 hrs
FFICE!
BOSTONIA CONDITA AD.
A.182
BOSTO
· MAS.S.
Contributory : 2
Opr.Uterine fibroid -
(Duration)
(Signed)
D D Scannell
M.D.
Mar. 9
1910 .................
SPECIAL INFORMATION from Hospitals, Institutions, Transier.ts, or Recent Residents.
Usual Residence
Winthrop
Filed
Mar 10
1910.
A true copy.
Attest :
ErMSlenen
Registrar.
STRAR'S
CITY
ITATIS
18 3D. ISREGIMINE DONATA A.
N
. years
FULL NAME
Ruth A Thompson
COMMONWEALTH OF MASSACHUSETTS
1389
RETURN OF A DEATH
FULL NAME
Elionos a. Beach.
Registered No.
Place of Death *
58 Buchanan St. Huithrole Center
Date of Death
Fuch 13.
Age
/ ... years
4 months
15 days
STATISTICAL DETAILS
SEX
COLOR
W
SINGLE, MARRIED, WIDOWED; OR DIVOROED
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER Edgar Beach
BIRTHPLACE OF FATHER novascotia
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER# Clicaux. DeC.
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL I!
Hintprof~ Com.
DATE OF BURIAL Unch 15 1900
UNDERTAKER ADDRESS IS. C. Skaggs It enmond
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from mar 6 196Q .... to June 18 1900, 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 :
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