Town of Winthrop : Record of Deaths 1913-1915, Part 100

Author: Winthrop (Mass.)
Publication date: 1913
Publisher:
Number of Pages: 1094


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 100


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


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


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


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


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


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


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


important. See instructions on back of certificate.


10 NAME OF FATHER


William H. mannen


PARENTS


12 MAIDEN NAME OF MOTHER


12 BIRTHPLACE OF MOTHER/ (State or country)


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant).


Kaline &. Maniniz


(Address)


Filed ... , 191


REGISTRAR


16 DATE OF DEATH


June 11


(Month)


(Day)


1919 ...


(Year)


I HEREBY CERTIFY that I have investigated the death of the deceased.


The CAUSE OF DEATH* was as follows :


Fracture of skulls + mine teple


mennes


accident


(Duration)


.......


... yrs.


mos.


ds.


Contributory


(SECONDARY)


·


mos.


ds.


(Signed)


france 12


191 .... (Address)


MEDICAL EXAMINER


M.D.


State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.


.8 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 dlsease contracted, If not at place of death ?.


Former or usual residence


DATE OF BURIAL


19 PLACE OF BURIAL OR REMOVAL Holywood Cemetery.


SO UNDERTAKER


ADDRESS


(City or town.)


[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


Male


4 COLOR OR RACE


Muito


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Single


6 DATE OF BIRTH VEht. (Month)


2,6


1899


17


(Day)


(Year)


7 AGE


15


yrs.


8


mos.


15 ds.


If LESS than 1 day. .... „ hrs.


or ..


min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


Student


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


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH D


Winthich


(No ...


17485 Winthrop


Charles Mannix


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


85 Mmthrop St.


St. ..... .Ward)


......


9 BIRTHPLACE


(State or country)


Quan Estoura


11 BIRTHPLACE OF FATHER (State or country)


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Precise statement of occu- pation 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 enginccr, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Lahorcr - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- kcepers 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 occu- pation whatever, write None.


Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Ccrebro-spinal fcver (the only definite synonym is "Epidemie 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, peritonacum, etc., Carcinoma, Sar. coma, etc., of. .. (name origin: "Cancer" is less definite; avoid usc of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular hcart discasc; Chronic interstitial nephritis, ctc. 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 merc symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Scnile," 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. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound cf head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of "Contributory."


Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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, ete.


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


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1915.


CITY OF BOSTON.


FULL NAME


LILLIAN LAMB


Registered No.


5837


CITY HOSPT.


1915.


Age


32


years


months


17


days.


STATISTICAL DETAILS.


SEX.


COLOR.


SINGLE, MARRIED, WID., DIV.


F


SIN


Maiden Name


Husband's Name


Birthplace


Name of Father


JOHN H LAMB


Birthplace of Father


ENGLAND


Maiden Name of Mother


ALICE E. JONES


Birthplace of Mother


WALES


(Signed)


E.W. WILSON M.D.


JUNE 13 1915


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


ADMITTED TO HOSPT. JUNE 11.1915


Place of Burial or removal UTICA .N. Y.


Undertaker


R. J . GRAHAM


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


1915,


from 1915, 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


GIST T PATDIRIS, SIT DE!


CITY RE


SICUT


Primary: (Duration)


GEN. PERITONITIS - I DAY


EFICE


BOSTONIA


TON TITAA


ISREGIMINE DONATA A 13 30.


STO


N


MASS


RUPT.PELVIC ABSCESS?


Contributory · (Duration)


SOCIAL SCIENCE WORKER


Occupation


Informant


Usual Residence WINTHROP( 233 WOODSIDE AV)


Filed


1915.


A true copy. Attest :


JUNE 16


Eumylenen


Registrar.


O


Place of Death }


Boston


and Residence 5


Date of Death


JUNE 12


ENGLAND


( OPR.JUNE 12.1915)


TA /.1822.


June 12, 191.


CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back of certificate.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Winthrop Hace. (No 106 Washington Une-se.


George W. Leur hebung


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


Ward)


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Male


4 COLOR OR RACE


While


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


Single.


6 DATE OF BIRTH


April.


Month)


(Day)


26


1846


17


(Year)


7 AGE


69


yrs.


1


mos.


19 ds.


6 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)


Pinchos - Maxz


10 NAME OF


FATHER


PARENTS


12 MAIDEN NAME OF MOTHER Joanna J'aite.


13 BIRTHPLACE


OF MOTHER


(State or country)


do Malacan Mara.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Vorar Teroles burg


(Address) 100 Har frames land fire


16


Filed 121 .......


....


REGISTRAR


16 DATE OF DEATH


June


(Month)


1 x ch 1913 (Year) (Day)


I HEREBY CERTIFY that I attended deceased from


Heh. 1ch


19115/to.


frem 14


1915


If LESS than I day ...... or min. ? .. hrs. that I last saw halle alive on 1915 and that death occurred, on the date stated above, at .m. The CAUSE OF DEATH* was as follows :


Carcinoma of small intestine


(Duration)


2


.yrs.


mos.


.ds.


Contributory


(SECONDARY)


(Duration)


.. yrs.


. mos.


(Signed)


Ml. Parte


free 15,1918 (Address)


Minehref


M.D.


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


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


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.


1ª PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


Weatherop Gemetenje June16.


191.5.


....


20 UNDERTAKER


ADDRESS


E .& Brown, Non Easy Grain.


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


106 Washington Ave.


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


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 needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return " Laborer," "Foreman," " Manager,""Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.) ... For persons who have no occupation whatever, write None.


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


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of .. (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms) ; Measles ; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy,""Exhaustion," "Heart failure," "Haemorrhage," " Inanition," "Marasmus," " Old 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.


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH-1915.


CITY OF BOSTON.


FULL NAME


JAMES YOUNG


Place of Death and Residence S


Boston


JUNE 17


87


1915.


Age


years


months days.


STATISTICAL DETAILS.


SEX.


COLOR.


SINGLE, MARRIED, WID., DIV.


M


MAR.


Maiden Name


Husband's Name


LUNENBERG . N.S.


Birthplace


Name of Father


JOHN YOUNG


TISRECIM'


HE DONATA A.


S S.


N


Contributory : ( ARTERIO-SCLEROSIS- YRS (Duration)


W. B.KEELER


(Signed)


M. D.


JUNE 18 1915


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


WINTHROP ( 583 SHIRLEY ST)


Usual Residence


Filed


JUNE 22 1915.


Undertaker


MELROSE (WYOMING)


D. H. CURTIS


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


from 1915, 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 1915,


R


FUT PATRIEAS


Primary: ( Duration ))


CHR.MYOCARDITIS - YRS


CITY


4.


BOSTONIA


AD. 1822.


Birthplace of Father


LUNENBERG. N.S.


Maiden Name of Mother


ELIZABETH BERINGER


LUNENBERG . N. S.


Birthplace of Mother


STORE KEEPER


Occupation


Informant


Place of Burial


or removal


O


A true copy. Attest : ErMSlenen


Registrar.


FICE


CIVITATIS COPITAA


BOSTO


Registered No.


6013


MC CREIGHT SAN.


Date of Death


June 17, 1915


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


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


Uncherto 1. 4.


(No.


....


Richiesta Porto Haftar


St. :


Williams Stearin Brown.


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


9 Belluno que Futbolo Maan


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


4 COLOR OR RACE


Nogle Valuta


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED Qual.


(Write the word)


16 DATE OF DEATH


18 "19 15-191


(Month)


(Day)


(Year)


$ DATE OF BIRTH


Maanche 22"/869, 1


(Month)


(Day)


(Year)


TAGE 46


yrs.


2 mos


27


ds.


or ......


min. ?


& OCCUPATION


(a) Trade, profession, or


particular kind of work


Connucl Jiveller,


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


9 BIRTHPLACE


(State or country)


1) Gambudgi Nocha.


10 NAME OF


FATHER


Fellini Le Brona.


PARENTS


11 BIRTHPLACE


OF FATHER


(State or country)


Cambridge Mama


12 MAIDEN NAME


OF MOTHER


Clean & Brun


Russell


1ª BIRTHPLACE


OF MOTHER


(State or country)


Delta D. H.


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informsnt)


(Address)


Imthale Namn


Filed


191


REGISTRAR


17


I HEREBY CERTIFY that I attended deceased from


191


...... to


......


.......


If LESS than


| day,


.. hrs.


that | last saw h


alive on


191


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


m.


The CAUSE OF DEATH* was as follows :


(Duration).


.yrs.


...........


mos.


........... ds.


Contributory.


(SECONDARY)


(Duration)


.. yrs.


mos.


ds.


(Signed)


M.D.


191


(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.


DATE OF BURIAL


que. 11"


1913-


ADDRESS


20 UNDERTAKER! Clan Te Htarticle


Schertu h 4


(City or town.)


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


Ward)


6370


$ SEX


...


191


DIANDAND VENTITIVAIC UI DLATIN


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


Statement of cause of death. - Name, first, the DIS- EASE 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


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 provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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.


COUNTERSIGNED BY THE BOARD OF HEALTH IN 23 1915


TECHEVAR. .


(Always write with ink)


TRANSIT PERMIT


R. M. SWINBURNE & Co., Printers, Rochester, N. Y.


TRANSPORTATION OF CORPSE


NEW YORK STATE DEPARTMENT OF HEALTH Transit Permit No.


CHESTER, N. 7


PERMIT OF LOCAL BOARD OF HEALTH


This Permit must be properly signed and presented, with Undertaker's Certificate, to the Railroad, Express


or other Transportation Agent, before a body can be shipped


Rochester


Co. of


Mourow


N. Y., ..


6/18


19/5


Bender


holder of Permission is hereby given.


Undertaker's License No.


307


to remove for burial at ..


Boston


Cemetery at


State of mass


, the body of


Um & Brown


6/18


195, at .M.


months. 27 days, sex color 26. , the cause of death being Colitis


which necessitates shipment under Rule No. 3 of the Rules of the New York State Department of Health


for the Transportation of the Dead, as printed on the back of this Permit. Route of Shipment.


1


(Signature of Undertaker) Bender Bras


Signed


Margaret O'malley.


Register


(Official Title) This Permit must be detached from "Transit Label" below and delivered to the Person in charge of the Corpse


( When obtainable)


who died at


Rochester


N. Y., on


Aged. 46 2 years


June 18, 1915


REGULATIONS RELATING TO THE TRANSPORTATION OF THE DEAD


THESE RULES HAVING BEEN DULY ADOPTED AND PROPERLY PUBLISHED, HAVE THE FORCE OF LAW


RULE I. A transit permit and transit label issued by the proper health authorities shall be required for each dead body transported by common carrier.


The transit permit shall state the name, sex, color and age of the deceased, the cause and date of death, the initial and terminal points, the date and route of shipment, a statement as to the method of preparation of the body, the date of issuance, the signature of the undertaker, the signature and the official title of the officer issuing the permit.


The transit label shall state the place and date of death, the name of the deceased, the name of the escort or consignee, the initial and terminal points, the date of issuance, the signature and official title of the officer issuing the permit, and shall be attached to the outside casc.




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