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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