USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 66
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).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121
Statement of cause of death. - Name, first, the DIS- CASE 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, ete., Carcinoma, Sar- coma, etc., of .... .... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasins) ; 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- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," ctc., when a definite discase can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septieaemia," "PUERPERAL peritonitis," ctc. 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.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Wieleof Mars (No. 163. Leall ane .St. ; Ward)
(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
3 SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
( Write the
Mand
6 DATE OF BIRTH
(Month) (Day) (Year)
7 AGE
If LESS than
I day ......... hrs.
55.
. yrs.
mos.
de.
or ....... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Hotel Rufen
(b) General nature of industry, business, or establishment In which employed (or employer).
& BIRTHPLACE
(State or country)
Portland. Mueve
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Onland
12 MAIDEN NAME
OF MOTHER
muitomais
13 BIRTHPLACE
OF MOTHER
(State or country)
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informsnt)
(Address) 16 3 Sévace in
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Sept
25
(Month)
(Day)
1914
(Year)
17 I HEREBY CERTIFY that I attended deceased from april 25 1914, to
Sept 25
1914
that I last saw h was alive on
Lapl. 25
191 8
and that death occurred, on the date stated above, at. m.
The CAUSE OF DEATH* was as follows : acute Dilatation of Heart
(Duration) ..
.. yrs.
mos/2
ds.
Contributory ..
(SECONDARY)
(Duration) yrs. mos. ds.
(Signed)
Laval 26, 199 (Address)
325 Mintegy M.D.
* If (teath 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.
In the
ds.
State
yrs.
.mos.
ds.
Where was disease contracted, If not at place of death ?.
Former or usual residence
18 PLACE OF BURIAL OR REMOVAL italy head Can Beashley
DATE OF BURIAL
191^
2 UNDERTAKER
ADDRESS
4 Camaybe
Filed 191 .......
...
Charles H. Hanlon
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
163 Surace Com
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
I
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 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 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, az A person found dead, etc.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1914.
CITY OF BOSTON. 8792
FULL NAME
Place of Death
Boston
and Residence
Date of Death
SEPT.26
1914.
Age
65
years
months days.
STATISTICAL DETAILS.
SEX.
COLOR.
M
W
SINGLE, MARRIED, WID., DIV. SIN.
Maiden Name
Husband's Name
IRELAND
Birthplace
Name of Father
JOHN HURLEY TYITATIS
BOSTONIA CONDITA AL
A /D.1822
Birthplace of Father
IRELAND
Maiden Name
MARGARET CALNAN
of Mother
Birthplace of Mother
IRELAND
PRESSMAN
Occupation
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1914, to 1914, 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 :
IS
RAR'
R
T PATRIBU'S.S. Primary! (Duration)
CITY
ISICUT
SOFFICE
AC. NEPHRITIS FOL. OPR.FOR
HERNIA
S
Contributory . ( Duration)
RHEUMATIC DIATHESIS
W. T. BAILEY
(Signed) SEPT.26 1914
M.D.
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal
MALDEN ( HOLY CROSS )
Undertaker
R.C. KIRBY
Usual Residence
WINTHROP ( 7 WILSHIRE ST)
Filed 1914.
A true cepy.
Attest :
OCT.I ErMSlenen
Registrar.
RF MINE DONATA
TON. MASS.
WILLIAM J. HURLEY
Registered No.
MASS. HOMEO. HOSPT.
Sept. 26, 1914
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
Winterof Mass
(No: 23
Neptune ave
Ward)
Winthrop (City or tewn.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Maron
Downs
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
23 Neptune Ave Winthrop Brass
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
mal
4 COLOR OR RACE
white
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Manuel
6 DATE OF BIRTH
(Month)
(Day)
(Year)
7 AGE
If LESS than
I day, .......
..... hrs.
47
.... yrs.
mos.
ds.
....... or ........ min. ?
8 OCCUPATION (a) Trade, profession, or particular kind of work
(b) General nature of industry,
business, or establishment in
which employed (or employer)
9 BIRTHPLACE
(State or country)
Boston
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Boston N.H.
12 MAIDEN NAME
OF MOTHER
Mary Connors
13 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mary Downs
(Address)
23 Neptune ave
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
IHEREBY CERTIFY that I attended deceased from
Jeps. 88, 191.
191.L.1. to
191.
14
that I last saw h ..... Malive on Suffi 28 /9/14 and that death occurred, on the date stated above, at 1,50m. 22 The CAUSE OF DEATH* was as follows : Ceramica
.yrs.
mos. C.
ds.
Contributory
(SECONDARY)
(Duration)
0 yrs.
mos.
ds.
M.O.
* 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.
19 PLACE OF BURIAL OR REMOVAL
LA Paul.
arlington
DATE OF BURIAL
Leps 30
191
4
20 UNDERTAKER
ADDRESS 75 Chambers St Boston 2020
28
(Month)
(Day)
(Year)
186
Filed 191
10 NAME OF
FATHER
Aaron Downs
(Signed)
5412 24914 (Address)
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: Cercbro-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 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.
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
William I Robicheaux
PARENTS
11 BIRTHPLACE
OF FATHER
(State or antee)
Charlestown KB,
12 MAIDEN NAME
OF MOTHER
Mary Sullivan
1$ BIRTHPLACE
OF MOTHER
(State or country)
St Colore 0/1.03,
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Hurban
(Address)
31 Read St
16
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
ort
(Day)
(Month)
4
1914
(Year)
17
I HEREBY CERTIFY that I attended deceased from
ort, +
1914
., to
191.9 ...
that I last saw her alive on
.....
oct x'
191Y,
and that death occurred, on the date stated above, at.
6 6m.
The CAUSE OF DEATH* was as follows :
Indented to Birth
Pregnancy (Casaarian Section
Did a surgical operation precede death ?
70 Date Outity
(Duration)
.yrs.
mos.
3
de.
Contributory
(SLCONDARY)
(Duration)
.yrs.
mos.
ds.
(Signed)
631 Dul cat
M.D.
* If death followed injury or violence the certificate of death inust be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death.
.......... yrs.
mos.
3 ds.
In the
29 yrs.
nos ..
ds .............
Where was disease contracted,
If not at place of death ?.
Former or
usual residence ......
12 PLACE OF BURIAL OR REMOVAL Holy Cross
DATE OF BURIAL
Got 7
1914
UUNDERTAKER
ADDRESS
Billy E Boston
(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
3 SEX
4 COLOR OR RACE
W.
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
de
&DATE OF BIRTH
(Month)
(Day)
1
(Year)
? AGE
30
.. yrs.
...... mos. ds. or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
If LESS than
[ day, ........ hrs.
(b) General nature of industry,
business, or establishment in
which employed (or employer).
9 BIRTHPLACE
(State or country)
Winthrop
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH 1 PLACE OF DEATH Metcalf Hospital Winthrop Many of Delancer
2 FULL NAME [If married or divorced woman or -dow give maiden name, also name of husband.] @RESIDENCE
39 Reader
BOSTON .......
St. :
.
Ward)
1914 (Address)
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 engineer, Civil engineer, Stationary fircman, 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 cxamples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery; (a) Forcman, (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, ete. 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 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: 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); Tubcr-
culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- coma, etc., of ... .. (name origin: "Caneer" 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," "Scnile," ctc.), "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, ete.
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.
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
Kultand
.(No ..... .........
St. :
....... Ward)
Rutland (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
' FULL NAME
Lena MC Donald Kimball
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Winthrop
Mc Donald
Husband name Chas. a.
Registered No.
71
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
W.
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married
$ DATE OF BIRTH
March
(Month)
(Day)
(Year)
"AGE
If LESS than
1 day .......... hrs.
20
yrs.
6
mos.
25 ds.
or ......... min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
House wife
(b) General nature of Industry,
business, or establishment i
which employed (or employer).
9 BIRTHPLACE
(State or country)
Boston
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Canada
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE
OF MOTHER
(State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
Rusland
16
Filled
Cout 6, 1914 Damit Haupt
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Getshar
5
(Month)
(Day)
191X
(Year)
17
I HEREBY CERTIFY that I attended deceased from
to
Zame 11
1914
Geoter 5
. 1914
that I last saw her
alive on
,
191€
and that death occurred, on the date stated above, at
90 P .... m. The CAUSE OF DEATH* was as follows : Pulmonary Tuberculosis
(Duration)
11
mos.
ds.
Contributory
Premier Thomas
(SECONDARY)
.(Duration)
.... yrs.
.mos.
3
ds.
(Signed)
Bay and T. 6 rane
... .
M.D.
..... 191 ..... (Address)
Rusland
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
10 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death ..
......
. yrs. ............ mos.
3 ds.
In the
State.
.... yrs. ........
mos.
ds ......
.......
Where was disease contracted,
If not at place of death ?...
Busta Lars
Former or
usual residence.
máss
19 PLACE OF BURIAL OR REMOVAL Worcester
DATE OF BURIAL
191
.......
20 UNDERTAKER
L.G. aty / 200
ADDRESS
Warcesty
.. Ayrs.
10 NAME OF
FATHER
Daniel & M: Donald
1
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 linc 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 tho 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 Nonc.
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.