Town of Winthrop : Record of Deaths 1910-1912, Part 51

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 51


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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The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


(No 6 3 Wennchiot Street St. :..


Ward)


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


2 FULL NAME


Betsey Baker Dalrymple


[If married or divorced woman or widow give maiden name, also name of husband.] wilow Eco. W. Dalrymple


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


COLOR OR RACE


mute


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


12


(Month)


(Day)


(Year)


(b) General nature of industry,


business, or establishment in


which employed (or employer).


9 BIRTHPLACE


(State or country)


Trota mais


11 BIRTHPLACE OF FATHER (State or country)


12 MAIDEN NAME OF MOTHER


1ª BIRTHPLACE OF MOTHER (State or country)


11 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Nuo S. L. De calor


(Address)


63 wunebast St wartung


5 Filed ., 191


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


18 19|/


(Month)


(Day)


(Year)


1833


17


I HEREBY CERTIFY that I attended deceased from


Dec 17, 191.


DEC 18 191


If LESS than I day, hrs. that I last saw h alive on Die 18, 1911 and that death occurred, on the date stated above, at 3 Pm. or ....... min, ? The CAUSE OF DEATH* was as follows : Primaria and Pleurisy


.. (Duration)


.. yrs.


.mos.


3 ds.


Contributory


arterio - Sclerosis and


SECONDARY)


Several mycards.


(Signed) Oralman Virtual


Dec 20, 1911 (Address)


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


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


At place


of death ..


yrs.


mos.


.ds.


State


.. . yrs.


in the


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


12/20 191


CO UNDERTAKER


ADDRESS


(a) Trade, profession, or


particular kind of work


.yrs.


10


mos.


6


ds.


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 singlo 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 sccond statement. Never return "Laborer," "Foreman," " Manager," "Dealer," etc., without more preciso specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housc- keepers who receive a definite salary), may be entered as Ilousewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be takon 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 ('AUSING 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-


1911 1


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 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, Ilomieidc, 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 strect, or one supposed to be due to Alcoholism, etc.


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


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. N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state -


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


85. Johnson St. ;...


Ward)


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


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


I HEREBY CERTIFY that I attended deceased from


Dem 18


. 1911, to


Du 18, 191


If LESS than


I day, ..


hrs.


that I last saw he alive on


Que 18


,1911.


and that death occurred, on the date stated above, at ... / P.


or


.min. ?


m.


The CAUSE OF DEATH* was as follows :


multiple abdominal Comme


.(Duration)


www .... yrs.


6


mos.


- ds.


Contributory (SECONDARY)


(Duration)


.yrs.


mos.


ds.


(Signed)


Der 20, 1911 (Address)


Winterof Wars


* 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).


In the


At place


of death


yrs ..


mos.


ds.


State.


.. . yrs. ..


mos.


ds ..


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


Former or usual residence


17 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


12/20


191 9


ADDRESS


Filed


191


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


6 DATE OF BIRTH


mar


14


18567


(Month)


(Day)


(Year)


7 AGE


55


.yrs.


10


mos.


4


.ds.


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


at home


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


House wife


) BIRTHPLACE


(State or country)


Ovide n.Y.


PARENTS


12 MAIDEN NAME OF MOTHER Cinderella Bailey


13 BIRTHPLACE OF MOTHER (State or country)


11 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(informant) ..


Bellen. H. Clike


(Address)


85 Johnson cont


REGISTRAR


(City or town.)


Lillie Elles Clarke


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


Clucajo


ele


wife of allen. It. Clarke


3 SEX


Manuel


4 COLOR OR RACE


volete


(Month)


(Day)


18


191


(Year)


:0 UNDERTAKER


6. K. Bennem.


...... ....


10 NAME OF


FATHER


Nachan- Palmer Ellis


11 BIRTHPLACE


OF FATHER


(State or country)


Ellio n.4


alec. 18, 1911


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. Tho 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, ospecially 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," otc., without more preciso specification, as Day laborer, Farm iaborer, Laborer - Coal minc, etc. Women at home, who are engaged in tho 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 it home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Serrant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE ('AUSING 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. - 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 ro- port " Typhoid pneumonia ") ; Lobar pneumonia ; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., C'arcinoma, Sur- coma, etc., of. .. (name origin: "Cancer" is less definite ; avoid use of " Tumor" for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart discase ; 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," "Senilo," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," "Marasmus," " Old age," "Shock," " Uraemia," " Weakness," ctc., 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, ctc.


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 dcad, etc.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


' PLACE OF DEATH P


(No.


St. ;...


Ward)


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


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


+ COLOR OR RACE


S


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED ×


(Write the word)


16 DATE OF BIRTH 1


1


(Month)


(Day)


(Year)


7 AGE


yrs. mos. ds.


or --


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


(b) General nature of industry,


business, or establishment in


which employed (or employer).


@ BIRTHPLACE


(State or country)


1


10 NAME OF


FATHER


PARENTS


12 MAIDEN NAME OF MOTHER


13 BIRTHPLACE OF MOTHER (State or country) 1


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


Filed


191


17 I HEREBY CERTIFY that I attended deceased from Weer 13, 1911, to


Dec. 18 1911.


If LESS than | day, ... hrs. that I last saw hace alive on Dec. 18 1911 and that death occurred, on the date stated above, at 5. C. m. min. ? The CAUSE OF DEATH* was as follows :


Cerebral Hemorrhage


.. (Duration) .. . .... yrs. mos. 5 ds


Contributory


arteria - acheraxes


(SECONDARY)


definite


(Duration)


yrs.


mcs.


ds.


(Signed)


M.D.


Dec. 19


19y/ .. (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.


ds.


State


.yrs.


In the


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


-


ADDRESS


:0 UNDERTAKER


in's ya


REGISTRAR


16 DATE OF DEATH


Dec.


(Month)


18. (Day)


191. (Year)


important. See instructions on back of certificate.


1


1


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


(City or town.)


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


11 BIRTHPLACE OF FATHER (State or country)


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 nceded. 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 statoment. Never return " Laborer," "Foreman," " Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborcr - Coal mine, etc. Women at home, who aro engaged in tho 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. Exampics: 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," unqualificd, 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 (sccondary), 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," "Haemorrhago," " 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


1 PLACE OF DEATH Winthrop Mast (No .: 30 Man. IT Edmund Ballen


St. :.. Ward)


BOSTON


(City or town.)


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


30 Many it malbry mais


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


December


22


(Month)


(Day)


191 1


(Year)


17 I HEREBY CERTIFY that I attended deceased from Dec. 7 1911,


to Dec. 22 1911 that I last saw him alive on Dec. 22 and that death occurred, on the date stated above, at /2 P.m. The CAUSE OF DEATH* was as follows : Lobar fines na


(Duration)


....... ..... yrs.


mos.


15


ds.


Contributory (SECONDARY)


(Duration)


.yrs. .


mos.


ds.


(Signed)


Edn


dr. moran


M.D.


Dec. 23, 1911 (Address


641 Bennington St ER


* 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


Note, Gross Walden


DATE OF BURIAL


Des 191


UNDERTAKER


Rtkirby


ADDRESS


E. Boston


2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 3 SEX 4 COLOR OR RACE 5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (Write the word) 6 DATE OF BIRTH (Month) (Day) 7 AGE 8 OCCUPATION 4 (a) Trade, profession, o: particular kind of work (b) General nature of industry, business, or establishment in which employed (or employer) 10 NAME OF FATHER Henry . PARENTS (Informant). Mother important. See instructions on back of certificate. Filed 191 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 1 yrs. 4 mos. ds.


9 BIRTHPLACE


(State or country)


Winthrop Mash


11 BIRTHPLACE OF FATHER (State or country) Barton Mars


12 MAIDEN NAME


OF MOTHER


Mary Carleton


18 BIRTHPLACE


OF MOTHER


(State or country)


& Boston


" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Address)


·Winthrop 2 Mars


REGISTRAR


(Year)


If LESS than


[ day ........


hrs.


or ....... min. ?


Dlac. 22,1911 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 engincer, 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 foru part of the second statoment. Never return "Laborer," "Foreman," " Manager,""Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Ilouse- 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 nooplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or iutercurrent) 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," ctc. 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 tho 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, E.c- posure, etc.


3. Sudden deathis of persons not disabled by recognized disease, as A death upon the street, or onc supposed to le due to Alcoholism, etc.


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


COMMONWEALTH OF MASSACHUSETTS.


RETURN OF A DEATH-1911. THOMAS FLAHERTY


CITY OF BOSTON. 11565


FULL NAME


MASS. GEN.HOSPT.


Place of Death } Boston


and Residence S


Date of Death


DEC.27


1911,


Age


61


years


months 4


.days.


STATISTICAL DETAILS.


SEX


COLOR


SINGLE, MARRIED, WID., DIV.


M


W


S


Maiden Name ..


Husband's Name


BOSTON (EAST)


Birthplace


JOHN FLAHERTY


Name of Father


IRELAND


Birthplace of Father.


Maiden Name of Mother


BOSTON


Birthplace of Mother


Occupation ... JANITOR


Informant.


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from 1911, to 1911, 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:


STRAR'S


PATRICUS, SIT DEL


Prima ( Duration)


CITY


TICE


FRAC. THIGH. PNEUMONIA & EX-


HAUSTION -- ELEVATOR ACCIDENT


STO


N. MASS.


Contributory : (Duration)


(Signed)


G.B. MAGRATH (MED. EX ]


M.D.


DEC.28 1911


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.


Place of Burial




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